Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2004
Randomized Controlled Trial Comparative Study Clinical TrialRadiofrequency lumbar facet denervation: a comparative study of the reproducibility of lesion size after 2 current radiofrequency techniques.
Radiofrequency facet denervation procedures are widely used for the treatment of chronic low-back pain. Currently, both temperature-controlled and voltage-controlled techniques are used. In this combined in vivo and in vitro study, the electrophysiologic consequences and the effects on lesion size of these techniques were determined. ⋯ There is no consistent relation between voltage and the temperature obtained during radiofrequency lumbar facet denervation. Temperature-controlled radiofrequency lesioning is preferred to create reproducible lesion sizes.
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Reg Anesth Pain Med · Sep 2004
Comparative StudyThe use of magnetic resonance imaging to evaluate the accuracy of a handheld ultrasound machine in localizing the sciatic nerve in the popliteal fossa.
Ultrasound has become an increasingly popular modality in facilitating the performance of peripheral nerve blocks. There is a paucity of data describing techniques of ultrasound-guided sciatic nerve blocks. By using magnetic resonance imaging (MRI) as a gold standard, the objective of this study was to describe the ability of a handheld ultrasound machine to accurately locate the sciatic nerve. ⋯ The data presented here suggest that the specific ultrasound machine evaluated in this study can accurately localize the sciatic nerve in the popliteal fossa.
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Reg Anesth Pain Med · Sep 2004
A study of the characteristics of single-injection insulated block needles in a biologic model.
Single-injection block needles are manufactured in many different lengths, diameters, and tip designs, but the literature contains no reports of methods to assess clinical characteristics of regional-block needles. A novel animal model for the assessment of the characteristics of single-injection regional anesthesia needles is described. ⋯ This type of biologic model can be used for the quantifiable and repeatable assessment of different needle tip designs. Needles with moderate resistance and high feel were preferred.
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Reg Anesth Pain Med · Sep 2004
ReviewNeuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence.
Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. ⋯ Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.
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Headache is a common symptom caused by a wide variety of diseases. Primary headaches include migraine, cluster headache, tension-type headache, and other less common diseases. It is important to differentiate these headaches from secondary headaches caused by vascular, neoplastic, infectious, metabolic, or toxic disorders. ⋯ Detoxification from the offending drug is essential for headache improvement. Cervicogenic headache is common and needs to be diagnosed correctly since it may require specific therapy. Nerve blocks are useful for some patients with primary, as well as secondary, headaches.