Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2000
Case ReportsComplete brachial plexus palsy after total shoulder arthroplasty done with interscalene block anesthesia.
This report illustrates that brachial plexus palsy can result from either interscalene block or total shoulder arthroplasty. It is often impossible to determine which procedure caused the deficit; therefore, we believe the focus should be placed on treatment of the neurologic deficit. This report provides a suggested algorithm for diagnosis and treatment of postprocedure brachial plexus palsy. ⋯ Proper diagnosis and treatment of postprocedure brachial plexus palsy may improve recovery of function. Several precautions may reduce the likelihood of brachial plexus palsy following interscalene block for total shoulder arthroplasty.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialEffects of immediately initiating an epidural infusion in the combined spinal and epidural technique in nulliparous parturients.
Intrathecal fentanyl with bupivacaine provides rapid labor analgesia of limited duration. We investigated the effect of initiating an epidural infusion of 0.1% ropivacaine with fentanyl 2 microg/mL and epinephrine 1:400,000 (REF) on the duration of analgesia and incidence of side effects after intrathecal injection in the combined spinal and epidural technique. ⋯ Initiating an infusion of REF prolongs the duration of analgesia, but also results in a greater decrease in blood pressure. Despite this effect on blood pressure, there was no difference in ephedrine use.
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Reg Anesth Pain Med · May 2000
Clinical Trial Biography Historical ArticleGeorg Perthes--the man behind the technique of nerve-tracer technology.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialProcaine compared with lidocaine for incidence of transient neurologic symptoms.
Transient neurologic symptoms (TNS) have been reported to occur after 16% to 40% of ambulatory lidocaine spinal anesthetics. Patient discomfort and the possibility of underlying lidocaine neurotoxicity have prompted a search for alternative local anesthetic agents. We compared the incidence of TNS with procaine or lidocaine spinal anesthesia in a 2:1 dose ratio. ⋯ The incidence of TNS was substantially lower with procaine than with lidocaine. However, procaine resulted in a lower overall quality of anesthesia and a prolonged average discharge time. If the shortfalls of procaine as studied can be overcome, it may provide a suitable alternative to lidocaine for outpatient spinal anesthesia to minimize the risk of TNS.