Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2000
Thoracic epidural anesthesia via the modified Taylor approach in infants.
Advancement of catheters from the caudal to the thoracic level is an alternative to thoracic epidural anesthesia in infants and younger children; however, contamination of the insertion site may occur. This study examined the feasibility of the midline modified Taylor approach (L(5)-S(1)) for the advancement of epidural catheters to the thoracic level in infants. ⋯ The midline modified Taylor approach allows access to the thoracic epidural space via catheter advancement, while being below the terminus of the spinal cord and less likely to suffer contamination than the caudal approach.
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Reg Anesth Pain Med · Nov 2000
Conduction block by clonidine is not mediated by alpha2-adrenergic receptors in rat sciatic nerve fibers.
Clonidine, an alpha(2)-adrenergic agonist, has been shown to prolong local anesthesia. It appears that clonidine by itself produces conduction block by acting on peripheral nerves. However, whether clonidine-induced conduction block is mediated through alpha(2)-adrenergic receptors remains unclear. The purpose of this study was to see if clonidine's nerve-blocking action was through alpha(2)-adrenergic receptors by examining clonidine's action in the presence of alpha(2)-adrenergic antagonists. ⋯ The results indicated that the mixture of clonidine and yohimbine, in which either drug inhibited impulse conduction, produced conduction block in an additive manner, and that clonidine-induced conduction block was not reversed by coapplication with a specific alpha(2)-adrenergic antagonist idazoxan. These data suggest that clonidine's effects likely depend on mechanisms not mediated by alpha(2)-adrenergic receptors.
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Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block. ⋯ SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.
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Reg Anesth Pain Med · Nov 2000
Comment Letter Comparative StudyRegional anesthesia with ropivacaine.