Regional anesthesia and pain medicine
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Based on case reports of early anastomotic leakage in patients receiving epidural analgesia with local anesthetic and data to document a stimulatory effect of epidural block on gastrointestinal motility, it has been suggested that continuous infusion of epidural local anesthetic may lead to an increased incidence of anastomotic leakage. Therefore, we examined the association between continuous epidural local anesthetic and anastomotic leakage by reviewing the literature. ⋯ So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to be associated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.
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Reg Anesth Pain Med · Mar 2001
Case ReportsThoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma.
The need for continual neurological assessment in patients with lumbar spinal injury poses a challenge for effective management of pain associated with multiple fractured ribs. Two cases are presented to illustrate the benefits of using thoracic paravertebral block to control the pain of multiple fractured ribs without compromising the ongoing neurological assessment. ⋯ Thoracic paravertebral block is an option for managing pain associated with multiple fractured ribs in the presence of concomitant lumbar spinal injury requiring continual neurological assessment.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEfficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study.
We assessed the efficacy and safety of dipyrone in comparison with tramadol in the relief of early postoperative pain following abdominal hysterectomy. ⋯ Dipyrone and tramadol showed similar efficacy for early pain relief after abdominal hysterectomy. Nausea and vomiting, possibly caused by the tramadol, occurred more frequently in those patients. In this group, the need of the antiemetic drug ondansetron was also higher.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialAssessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy.
The effectiveness of local anesthetic wound infiltration for treatment of postoperative pain appears to be variable and partly dependent on the surgical procedure. Although evidence was lacking, it was common practice at our institution to infiltrate the trocar wound of patients undergoing day-case laparoscopic procedures with long acting local anesthetic agents. The aim of this study was to investigate the analgesic efficacy, and the influence of the timing, of local anesthetic infiltration into surgical wounds for day-case diagnostic gynecological laparoscopy. ⋯ Wound infiltration with local anaesthetic did not significantly reduce pain or opioid requirement after gynecological laparoscopy.