Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2002
Meta Analysis Comparative StudyIntrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.
Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. ⋯ Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.
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Reg Anesth Pain Med · Jan 2002
Randomized Controlled Trial Clinical TrialMultimodal analgesia and intravenous nutrition preserves total body protein following major upper gastrointestinal surgery.
This study examined whether perioperative multimodal analgesia (MMA) improves the effectiveness of intravenous nutrition (IVN) as a means of preventing protein wasting following major upper abdominal surgery (UAS). The MMA regimen utilized combined epidural opioid/local anesthetic and the systemic nonsteroidal anti-inflammatory drug (NSAID) ketorolac for 48 hours. ⋯ In conclusion, we have shown that the combination of MMA and IVN prevents protein loss and improves pain control after major UAS. Our results suggest that after UAS, MMA significantly reduced pain and, in combination with IVN, preserves total body protein and fat. This is the first direct evidence of such effects associated with a commonly used multimodal regimen.
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Reg Anesth Pain Med · Jan 2002
Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects.
The infraclavicular approach to the brachial plexus is little used despite theoretical advantages of the technique. Using a vertical paracoracoid approach, we assessed the extent of the sensory block and the incidence of adverse effects. ⋯ Single injection infraclavicular block, using a vertical paracoracoid approach, appears suitable for surgery distal to the elbow. Selective anesthesia of the medial cutaneous nerve is useful in improving tolerance of the tourniquet.
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Reg Anesth Pain Med · Jan 2002
Case ReportsLow-dose intravenous lidocaine as treatment for proctalgia fugax.
Proctalgia fugax is characterized by a sudden internal anal sphincter and anorectic ring attack of pain of a short duration. ⋯ Based on the experience reported in this case and the potential benefit of this treatment for proctalgia fugax, controlled studies comparing intravenous lidocaine with placebo should be conducted to confirm the observation and to provide a more concrete basis for the use of intravenous lidocaine for this indication.