Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialSpinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison.
The aim of this prospective, randomized, double-blinded study was to compare clinical efficacy and safety of ropivacaine and bupivacaine given intrathecally in combination with morphine for cesarean delivery. ⋯ Spinal anesthesia produced with 20 mg ropivacaine plus 0.1 mg morphine is as effective and safe as that provided by 15 mg bupivacaine plus 0.1 mg morphine, with an earlier recovery of sensory and motor functions after surgery.
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Baclofen is a GABA(B) agonist that is administered spinally via an implanted drug delivery device to treat spasticity. It has been shown to have powerful antinociceptive effects in experimental animal models at doses that produce little or no motor-blocking effects but has rarely been used as a spinal analgesic agent in patients without spasticity. ⋯ To date, only 3 studies have shown it to be effective in patients with peripheral nociceptive or neuropathic pain mechanisms. Combinations of baclofen and morphine or clonidine are more effective than each drug alone in clinical as well as animal studies.
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Reg Anesth Pain Med · May 2004
Review Case ReportsSpinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology.
The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation. ⋯ Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications. Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.
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Reg Anesth Pain Med · May 2004
ReviewSelective nerve root blocks for low back pain and radiculopathy.
In the management of patients with low back pain and radiculopathy, selective nerve root blocks (SNRBs) are now a common procedure for both diagnostic and therapeutic purposes. This article reviews the available studies as well as the relevant anatomy, pathology, technical considerations, and complications.
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Reg Anesth Pain Med · May 2004
Comparative StudyInjection pressures by anesthesiologists during simulated peripheral nerve block.
Anesthesiologists typically rely on a subjective evaluation ("syringe feel") of possible abnormal resistance to injection while performing a peripheral nerve block (PNB). A greater force required to perform the injection is believed to be associated with intraneural injection. The hypothesis of this study is that anesthesiologists vary in their perception of "normal" injection force, that the syringe feel method is inconsistent in estimating resistance, and that needle design may affect the injection force. ⋯ Anesthesiologists vary widely in their perception of appropriate force and rate of injection during PNB. The syringe-feel method of assessing injection force is inconsistent and may be further affected by variability in needle design.