Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Sep 2003
Randomized Controlled Trial Clinical TrialNo anesthetic or analgesic benefit of neostigmine 1 mg added to intravenous regional anesthesia with lidocaine 0.5% for hand surgery.
Neostigmine has shown analgesic benefit when used as an adjunct to epidural or intrathecal anesthesia and analgesia, but evidence of benefit in the peripheral nervous system is controversial. This study aimed to determine if neostigmine 1 mg added to intravenous regional anesthesia (IVRA) provided any advantage in terms of intraoperative anesthesia or postoperative analgesia. ⋯ Neostigmine 1 mg provides no anesthetic or analgesic advantage when added to IVRA for upper limb surgery.
-
Reg Anesth Pain Med · Sep 2003
Comparative Study Clinical TrialComparison of heart rate response to an epinephrine test dose and painful stimulus in children during sevoflurane anesthesia: heart rate variability and beat-to-beat analysis.
During regional anesthesia, various stimuli leading to an adrenergic response can occur. However, simulation of an epidural test dose by using intravenous administration of epinephrine (EPI) has always been compared with an intravenous saline infusion as the control. The aim of this study was to evaluate the possibility of distinguishing in children the effect on HR by an intravascular epinephrine infusion and a painful stimulus, using heart rate variability (HRV) and beat-to-beat analysis of HR. ⋯ Detection of the secondary HR decrease, 60 seconds after the first change in HR, allows us to distinguish the effects of a painful stimulus from those related to the epinephrine test dose at 1 MAC of sevoflurane. This secondary HR decrease induced by epinephrine appears primarily because of a compensatory increase in parasympathetic tone.
-
Ambulatory perineural local anesthetic infusion is a relatively new method for providing postoperative analgesia, and many aspects of this technique remain in the domain of conjecture and speculation. This retrospective chart review and survey was undertaken to investigate patients' opinions on various aspects of their ambulatory perineural infusion experience. ⋯ This investigation suggests that perineural local anesthetic infusion is generally well tolerated by ambulatory patients.
-
Reg Anesth Pain Med · Sep 2003
Altered perceptions after upper and lower extremity blocks: an initial investigation.
Nerve blocks frequently produce unusual altered perceptions in the extremities. We examined perceptual changes experienced after peripheral blocks. ⋯ The results of this study confirm and quantify the perceptions experienced by patients undergoing upper and lower extremity blocks. These perceptions are prevalent. This knowledge is helpful in providing patients with accurate preoperative preparation. Further investigation is warranted to determine the neurologic etiology of these observations.