Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialLateral approach to the sciatic nerve in the popliteal fossa: a comparison between 1.5% mepivacaine and 0.75% ropivacaine.
Ropivacaine and mepivacaine are commonly used local anesthetics for peripheral nerve blockade. The purpose of the present study was to compare onset time, quality of anesthesia, and duration of analgesia with ropivacaine 0.75% and mepivacaine 1.5% for lateral popliteal nerve block. ⋯ Both ropivacaine and mepivacaine provided effective sciatic nerve blockade. Mepivacaine 1.5% displayed a significantly shorter onset time than ropivacaine 0.75%. Postoperatively, ropivacaine 0.75% resulted in longer-lasting analgesia and less need for oral pain medication.
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Reg Anesth Pain Med · Nov 2003
ReviewCognitive-behavioral approach to the treatment of chronic pain patients.
Chronic pain is both prevalent and costly. Despite advances in understanding the anatomy, physiology, and biochemistry of nociception and development of potent analgesic agents and advanced technology, a significant number of people continue to experience pain and related disability. The perception of and response to pain are influenced by cognitive, affective, and behavioral factors as well as physical pathology. In this article, a selective review of research supporting the important contributions of psychologic factors is provided, a cognitive-behavioral perspective to understanding pain is presented, an integrative treatment and rehabilitation approach based on this perspective is described, and some of the evidence supporting the effectiveness of this treatment approach is summarized. ⋯ Chronic pain by definition persists over a long period-it is a chronic disease. Even the most sophisticated treatments are incapable of eliminating all pain for all pain sufferers. There is also tremendous variation in how patients respond to treatments provided and prescribed. Better treatment outcomes are likely to occur when the psychologic contributors and the physical factors involved are addressed. Moreover, a treatment approach based on the cognitive-behavioral perspective should help patients adapt to residual pain that remains after currently available treatments are undertaken. Thus cognitive-behavioral treatments should be viewed as important complements to more traditional pharmacological, physical, and surgical interventions.
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Reg Anesth Pain Med · Nov 2003
Comparative StudySubarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
The incidence of postdural puncture headache (PDPH) after epidural wet tap for obstetric patients may be as high as 75%. We have studied how subsequent placement of a subarachnoid catheter immediately after confirmation of a wet tap, and leaving the catheter in place for 24 hours affects the incidence of PDPH. ⋯ Subarachnoid catheter placement after wet tap in obstetric patients reduces the PDPH rate and does so to a greater extent if left in place for 24 hours after delivery.