Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jul 2003
Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in medicare patients.
The effect of postoperative epidural analgesia (vs. systemic analgesia) on patient outcomes is unclear. Available randomized controlled trials (RCTs) have focused on the intraoperative period and not properly examined the effect of postoperative epidural analgesia (EA) on outcomes. ⋯ The use of postoperative EA was not associated a lower incidence of mortality and major morbidity in Medicare patients undergoing total hip arthroplasty. However, the results should be interpreted with caution because of limitations in using the Medicare claims data for analysis. Further trials using other properly conducted and designed studies (e.g., RCTs) would be ideal to validate these results.
-
In this study, we have performed hypogastric plexus block using a posterior transdiscal approach in 20 patients diagnosed with pelvic pain because of cancer. ⋯ Transdiscal approach to the hypogastric plexus appears to be a safe and effective procedure. However, prospective randomized controlled studies comparing different approaches are needed to increase our knowledge of hypogastric plexus block.
-
Reg Anesth Pain Med · Jul 2003
Case ReportsShoulder dislocation after infraclavicular coracoid block.
We report a case of shoulder dislocation after a brachial plexus block with a double-injection technique using the infraclavicular coracoid approach. ⋯ When motor block of the muscles of the shoulder occurs after brachial plexus anesthesia, special care must be taken in patient positioning to avoid shoulder dislocation.
-
Reg Anesth Pain Med · Jul 2003
Case ReportsEpidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain.
We present a case of intense herpes zoster-related pain and itching in the ophthalmic division of the trigeminal nerve (V1). Successful pain and itch management was achieved after insertion of a high thoracic epidural catheter with a continuous infusion of bupivacaine and clonidine. ⋯ High thoracic epidural infusion of bupivacaine and clonidine was beneficial in relieving neuropathic itch in a patient with acute herpes zoster-related pain in the distribution of the trigeminal nerve.
-
Reg Anesth Pain Med · Jul 2003
Case ReportsContinuous regional anesthesia before surgical peripheral sympathectomy in a patient with severe digital necrosis associated with Raynaud's phenomenon and scleroderma.
Digital ischemia and necrosis caused by Raynaud's phenomenon in patients with connective tissue diseases may not respond to medical therapy and may have major adverse effects on quality of life. We describe the use of continuous ambulatory regional anesthesia for diagnosis and treatment before peripheral sympathectomy in a patient with secondary Raynaud's phenomenon. ⋯ Continuous ambulatory regional anesthesia appears effective as a treatment bridge for vasospasm and ischemia associated with secondary Raynaud's phenomenon. The enhancement of peripheral blood flow achieved with the regional anesthetic technique suggests that surgical peripheral sympathectomy may provide long-term benefits.