Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2002
Case ReportsOpioid-free analgesia following total knee arthroplasty--a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac.
Traditionally, postoperative analgesia following total knee arthroplasty (TKA) has been provided by neuraxial or peripheral regional techniques with supplemental administration of opioids. We report an alternative method of postoperative pain management for patients undergoing TKA in whom the use of systemic or neuraxial opioids may result in significant side effects. ⋯ A multimodal approach consisting of continuous lumbar plexus (psoas) block and nonopioid analgesics successfully provided postoperative pain relief in our patient and facilitated her physical rehabilitation after total knee arthroplasty.
-
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.
-
Reg Anesth Pain Med · Jan 2002
Case ReportsA portable mechanical pump providing over four days of patient-controlled analgesia by perineural infusion at home.
Local anesthetics infused via perineural catheters postoperatively decrease opioid use and side effects while improving analgesia. However, the infusion pumps described for outpatients have been limited by several factors, including the following: limited local anesthetic reservoir volume, fixed infusion rate, and inability to provide patient-controlled doses of local anesthetic in combination with a continuous infusion. We describe a patient undergoing open rotator cuff repair who was discharged home with an interscalene perineural catheter and a mechanical infusion pump that allowed a variable rate of continuous infusion, as well as patient-controlled boluses of local anesthetic for over 4 days. ⋯ Continuous, perineural local anesthetic infusions are possible on an ambulatory basis for multiple days using a portable, programmable pump that provides a variable basal infusion rate, patient-controlled boluses, and a large anesthetic reservoir.
-
Reg Anesth Pain Med · Jan 2002
Intrathecal lidocaine causes posterior root axonal degeneration near entry into the spinal cord in rats.
The neurotoxicity of lidocaine is not fully understood, and the primary lesion of lidocaine-induced spinal neurotoxicity has not been defined. Here we examine the effects of various concentrations of intrathecally administered lidocaine. ⋯ Our results suggest that spinal lidocaine neurotoxicity after supra-clinical concentrations of lidocaine is limited initially to the posterior roots at their entry to the spinal cord, and the extent and severity of the lesions are closely associated with lidocaine concentration. Unlike severe lesions in rats injected with 20% lidocaine, mild lesions caused by lower concentrations may not manifest neurofunctional deficits.
-
Reg Anesth Pain Med · Jan 2002
Regional anesthesia and pain medicine: residency training--the year 2000.
A survey of anesthesiology training programs in 1980 reported the use of a regional anesthetic technique in 21.3% of cases. A similar survey of anesthesiology training programs in 1990 reported that the use of regional anesthetic techniques had increased to 29.8%. Over the ensuing 10 years, additional changes have occurred in the field of anesthesiology and its United States residency training programs. This manuscript reports the impact these changes have had on the use of regional anesthesia techniques in residency training programs in the year 2000. ⋯ Anesthesiology training programs now appear to provide a satisfactory exposure to regional anesthesia for a majority of resident trainees, although 40% of residents may still be deficient in nerve block anesthesia. The growth in the use of regional anesthesia during residency has plateaued over the past decade, but the discrepancy between individual resident experience has improved.