Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2002
Randomized Controlled Trial Clinical TrialGabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study.
Severe phantom limb pain after surgical amputation affects 50% to 67% of patients and is difficult to treat. Gabapentin is effective in several syndromes of neuropathic pain. Therefore, we evaluated its analgesic efficacy in phantom limb pain. ⋯ After 6 weeks, gabapentin monotherapy was better than placebo in relieving postamputation phantom limb pain. There were no significant differences in mood, sleep interference, or activities of daily living, but a type II error cannot be excluded for these variables.
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Eisenmenger's syndrome is characterized by right-to-left or bidirectional shunting and pulmonary hypertension. Perioperative risk is high for noncardiac surgery, and many clinicians avoid regional anesthesia because of the potential deleterious hemodynamic effects. We determined perioperative mortality based on published reports describing anesthetic management in patients with Eisenmenger's syndrome. ⋯ This review of anesthesia and surgery in patients with Eisenmenger's syndrome reveals that most deaths probably occurred as a result of the surgical procedure and disease and not anesthesia. Although perioperative and peripartum mortalities are high, many anesthetic agents and techniques have been used with success.
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Reg Anesth Pain Med · Sep 2002
Case ReportsRepeated failure of epidural analgesia: an association with epidural fat?
To report the case of a patient who experienced repeated failed epidural analgesia associated with an unusual amount of fat in the epidural space (epidural lipomatosis). ⋯ We have described a case of repeated failure of epidural analgesia in a patient with epidural lipomatosis.
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Reg Anesth Pain Med · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialEpidural blockade suppresses lipolysis during major abdominal surgery.
The purpose of the study was to investigate the effect of thoracic epidural administration of local anesthetic, i.e., epidural block on perioperative lipolysis. ⋯ Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.
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Reg Anesth Pain Med · Sep 2002
Case ReportsAnalgesic effects of ketamine ointment in patients with complex regional pain syndrome type 1.
Ketamine hydrochloride (KET), an agent used for general anesthesia, has local anesthetic effects and N-methyl-D-aspartate (NMDA) receptor antagonist action. Because recent studies emphasized the role of peripherally distributed NMDA receptors in processing the nociceptive information, we investigated whether peripheral application of the ointment containing KET is able to attenuate the symptoms of local neuropathic pain. ⋯ Topical application of KET appears to be beneficial for the patients with acute early dystrophic stage of CRPS I because of either its local anesthetic effect or NMDA receptor antagonist action. Patients with chronic atrophic stage of CRPS I and CRPS II patients do not appear to respond to this treatment.