Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2000
Case ReportsCircumcision supplemented by dorsal penile nerve block with 0.75% ropivacaine: a complication.
Dorsal penile nerve block is a common procedure and can provide effective analgesia after penile surgery. Ischemic complications are rare and generally result from trauma or inadvertent administration of vasoconstrictive solutions. ⋯ Theoretical concerns over the vasoconstrictive properties of ropivacaine may be sufficient to avoid its use where the potential for ischemia to end organs is present.
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Reg Anesth Pain Med · Jul 2000
Clinical Trial Controlled Clinical TrialRespiratory gas exchange and hemodynamics during lumbar epidural anesthesia: effects of lidocaine with and without epinephrine.
Epinephrine modifies the hemodynamic response to epidural local anesthetic; effects on respiratory gas exchange are not known. We hypothesized that epidural epinephrine would increase oxygen consumption and carbon dioxide production. ⋯ The addition of epinephrine, 5 microg x mL(-1), to the epidural injection of 2% lidocaine is associated with changes not only in hemodynamics, but also in respiratory gas exchange.
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Reg Anesth Pain Med · Jul 2000
Clinical TrialInterscalene block with a nerve stimulator: a deltoid motor response is a satisfactory endpoint for successful block.
The interscalene brachial plexus block (ISB) is an effective and well-established anesthetic technique for shoulder surgery. Using nerve stimulation as an aid in block placement, a motor response (twitch) in the biceps or a more distal upper limb muscle has been recommended to indicate accurate needle placement. Our clinical experience, as well as anatomic reasoning, suggests that a deltoid twitch may be just as effective as one in the biceps for predicting successful block. This prospective clinical study was undertaken to compare a deltoid with a biceps twitch with respect to onset and success of motor block. ⋯ A deltoid twitch is as effective as a biceps twitch in determining accurate needle placement for ISB and in predicting successful motor block. Acceptance of a deltoid twitch during ISB eliminates the need for further probing and may translate into better patient acceptance and in a smaller risk of needle-induced nerve damage.
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Dura-arachnoid puncture for spinal anesthesia is associated with several complications. Postdural puncture headache (PDPH) and needle bending are significant among these. The incidence of PDPH has been reduced significantly with the advent of pencil-point needles. ⋯ Braun, Melsungen, Germany) has been modified manually. The new tip-holed design seems to be sound both from theoretical and practical point of view. Searching Medline Plus through their Internet Web site (www.nlm.nih.com) did not reveal the existence of any such spinal needle.