Regional anesthesia and pain medicine
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Skeletal muscle toxicity is a rare and uncommon side effect of local anesthetic drugs. Intramuscular injections of these agents regularly result in reversible myonecrosis. The extent of muscle damage is dose dependent and worsens with serial or continuous administration. ⋯ In this respect, the quantitative impact of further mitochondria-mediated pathways--at least in bupivacaine toxicity--is still to be established. Although experimental myotoxic effects are impressively intense and reproducible, only a few case reports of myotoxic complications in patients after local anesthetic administrations have been published. In particular, the occurrence of clinically relevant myopathy and myonecrosis has been described after continuous peripheral blocks, infiltration of wound margins, trigger point injections, and peri- and retrobulbar blocks.
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Reg Anesth Pain Med · Jul 2004
Randomized Controlled Trial Clinical TrialRopivacaine 3.75 mg/ml, 5 mg/ml, or 7.5 mg/ml for cervical plexus block during carotid endarterectomy.
To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of cervical plexus block during carotid endarterectomy. ⋯ The best quality of cervical plexus block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.
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Reg Anesth Pain Med · Jul 2004
Case ReportsUltrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease.
Interest in ultrasound-guided nerve block is increasing, but clinical utility still is being determined. We report a case in which ultrasound imaging aided nerve localization during popliteal block. ⋯ Ultrasound guidance can facilitate lateral popliteal catheter insertion in patients in whom electrolocation has failed.
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Reg Anesth Pain Med · Jul 2004
Case ReportsFemoral nerve injury complicating continuous psoas compartment block.
The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. ⋯ Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.
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Reg Anesth Pain Med · Jul 2004
Case ReportsCombined spinal-epidural technique for vaginal hysterectomy in a patient with Machado-Joseph disease.
Machado-Joseph disease is a form of progressive spino-cerebellar ataxia with both bulbar and peripheral neurological manifestations. To date, anesthesia for patients affected by this disease has not been described. General anesthesia may be problematic because of the risk of pulmonary aspiration and hypoxia. We describe our experience with the successful use of combined spinal-epidural in a patient with Machado-Joseph Disease (MJD). ⋯ Central neuraxial anesthesia is an option for patients with MJD presenting for lower abdominal and lower extremity operations. Combined spinal-epidural anesthesia confers hemodynamic stability yet allows for augmentation of intraoperative anesthesia and postoperative analgesia.