Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2000
Case ReportsUse of computed tomography for maxillary nerve block in the treatment of trigeminal neuralgia.
Maxillary nerve block has traditionally been performed by using external anatomic landmarks. However, the classic approach to the nerve may be confounded because of anatomic variability. We describe a technique for the block using the suprazygomatic route guided by computed tomography (CT). ⋯ A maxillary nerve block guided by a CT imaging is an alternative to classic techniques.
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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 Trial Controlled Clinical TrialEMLA reduces acute and chronic pain after breast surgery for cancer.
A significant percentage of women undergoing breast surgery for cancer may develop neuropathic pain in the chest, and/or ipsilateral axilla and/or upper medial arm, with impairment in performing daily occupational activities. We designed this study to determine if the perioperative application of EMLA (eutectic mixture of local anesthetics; AstraZeneca) cream in the breast and axilla area reduces analgesic requirements, as well as the acute and chronic pain after breast surgery. ⋯ The application of EMLA to patients undergoing breast surgery for cancer reduced the postoperative analgesic requirements and the incidence and intensity of chronic pain.
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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.