Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2005
Randomized Controlled TrialContinuous versus single-injection lumbar plexus blocks: comparison of the effects on morphine use and early recovery after total knee arthroplasty.
Continuous lumbar plexus infusion of local anesthetic after total knee arthroplasty has been shown to improve analgesia and early recovery as compared with patient-controlled analgesia (PCA) morphine. Any benefit of an infusion over a single-injection lumbar plexus block has not been directly shown however. ⋯ Postoperative infusion of local anesthetic around the lumbar plexus reduces morphine requirement and improves early recovery after total knee arthroplasty as compared with a single-injection block.
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Reg Anesth Pain Med · Nov 2005
Clinical TrialA description of the spread of injectate after psoas compartment block using magnetic resonance imaging.
Magnetic resonance imaging (MRI) provides for excellent visualization of spread of solution after peripheral nerve block. The aim of this observational study was to utilize MRI to describe the distribution of injectate (gadopentetate dimeglumine) administered for continuous psoas compartment block (PCB) performed by use of two approaches (Capdevila and modified Winnie) and to describe the spread of injectate to the lumbar plexus. ⋯ The most common pattern of injectate spread seen on MRI with both approaches to PCB was spread within the body of the psoas muscle around the lumbar branches (L2-4), with cephalad spread to the lumbar nerve roots. One catheter resulted in injectate between the psoas and quadratus lumborum muscles.
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Reg Anesth Pain Med · Nov 2005
ReviewAcute toxicity of local anesthetics: underlying pharmacokinetic and pharmacodynamic concepts.
The risk of accidental intravascular injection and consequent acute toxicity is ever-present with most neural blockade techniques. The severity of cardiovascular and central nervous system (respectively, CVS and CNS) toxicity is directly related to the local anesthetic potency, dose, and rate of administration. Nonetheless, although the anesthetic potency of ropivacaine and levobupivacaine is similar to that of bupivacaine, at usual clinical doses, ropivacaine and levobupivacaine are less likely than bupivacaine to cause convulsions or lethal dysrhythmias. ⋯ This is an underlying tenet of dose fractionation, but the main advantage of dose fractionation is that the anesthesiologist is able to cease administration with less of the dose given if signs or symptoms of toxicity occur. Overall, it appears that the gains in safety from ropivacaine and levobupivacaine are due more to favorable pharmacodynamic enantioselectivity than to pharmacokinetic factors. This essay presents some pharmacokinetic aspects relevant to acute toxicity of local anesthetics, mainly using data from the authors' studies in a sheep model of simulated accidental intravenous administration.
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Reg Anesth Pain Med · Nov 2005
Randomized Controlled TrialPerioperative pain management education: a short structured regional anesthesia course compared with traditional teaching among medical students.
Previous research has demonstrated that a brief course on pain management improved knowledge and attitudes toward analgesic use among medical students. The purpose of this study is to compare a structured clinical instruction course on regional anesthesia techniques for perioperative pain management with traditional teaching given to senior medical students. ⋯ A structured clinical instructional course on regional techniques for perioperative pain management given to fourth-year medical students can significantly improve their understanding and knowledge compared with traditional teaching.
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Reg Anesth Pain Med · Nov 2005
Correlation of postoperative pain to quality of recovery in the immediate postoperative period.
It is unclear whether the severity of postoperative pain may affect patients' quality of recovery in the immediate postoperative period (within 2 weeks of surgery). ⋯ Our findings suggest that an increase in postoperative pain is correlated with a decrease in a patient's quality of recovery in the immediate postoperative period.