Regional anesthesia and pain medicine
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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.
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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.
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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.
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Reg Anesth Pain Med · Jan 2002
Gabapentin decreases membrane calcium currents in injured as well as in control mammalian primary afferent neurons.
Neuropathic pain following injury to peripheral sensory neurons is a common clinical problem and frequently difficult to treat. Gabapentin (GBP), a novel anticonvulsant, has significant analgesic effects in clinical neuropathic states and in relevant preclinical models, but its mechanism of action remains unclear. Because calcium currents play a significant role in neuronal function, this study was designed to assess the effect of GBP on the membrane voltage-activated inward calcium currents (I(Ca)) in dorsal root ganglia (DRG) primary afferent neurons of neuropathic versus control rats. ⋯ GBP, at clinically relevant concentrations, results in significant reduction of I(Ca) in both sham and neuropathic neurons, while in nonoperated rats reduced I(Ca) to a smaller degree. Sensitivity to drug was not affected by neuropathy. This current inhibition is partly voltage dependent. Depression of I(Ca) may be partly related to the binding of the drug to the alpha(2)delta modulatory subunit of the voltage activated calcium channels (VACC). Analgesia may be due to diminished release of neurotransmitter by sensory neurons, a Ca(2+)-dependent process.