Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2006
Use of sequential electrical nerve stimuli (SENS) for location of the sciatic nerve and lumbar plexus.
Conventional electrical stimulation has been done by continuous adjustment of current amplitude at a single, set pulse duration (conventionally, 0.1 ms). This study evaluated a novel technique for nerve location by utilization of a peripheral-nerve stimulator (PNS) programmed to deliver sequential electrical nerve stimuli (SENS). A repeating series of alternating sequential pulses of 0.1, 0.3, and 1.0 ms at 1/3-second period intervals between pulses were generated so that at a greater distance from the nerve, only higher-duration pulses would stimulate the targeted nerve and result in 1 or 2 motor responses (MR) per second. Three MR per second at 0.5 mA or less signified the conventional endpoint for nerve location (=0.5 mA, 0.1 ms) because that value indicated that the 0.1-ms pulse was effective. The conventional 0.1-ms pulse served as a built-in control to which the SENS was compared. ⋯ SENS resulted in increased sensitivity without compromising specificity of nerve location.
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Reg Anesth Pain Med · Sep 2006
Single-stimulation, low-volume infraclavicular plexus block: influence of the evoked distal motor response on success rate.
We compared the success rate of single-injection infraclavicular plexus block by using electrically evoked radial, ulnar, or median nerve-type distal motor response to guide the injection of local anesthetic. ⋯ We showed that evoked distal motor response influenced the success rate of single-injection infraclavicular plexus block. The highest success rate was obtained when injection was performed after radial nerve-type motor response.
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Reg Anesth Pain Med · Sep 2006
The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound.
Seeking paresthesia and obtaining a motor response to an electrical stimulus are the two most common methods of nerve localization for the performance of peripheral-nerve blocks. However, these two endpoints do not always correlate, and the actual sensitivity and specificity of either method remains unknown. The objective of this study is to determine the sensitivity of paresthesia and motor response to electrical nerve stimulation as tools for nerve localization when a 22-gauge insulated needle is used for the performance of axillary-nerve block. ⋯ The very different and relatively low sensitivity of either technique may explain, in part, the lack of correlation previously reported between the 2 endpoints.
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Reg Anesth Pain Med · Sep 2006
Case ReportsGanglionic local opioid application (GLOA) for treatment of chronic headache and facial pain.
This report describes the effects of ganglionic local opioid application (GLOA) in patients with chronic headache and persistent idiopathic facial pain. ⋯ These results support the theory of sympathetically mediated pain in the head and face, the presence of opioid receptors on the sympathetic ganglia, and a possible beneficial role of opioids in modulation of this process. To our knowledge, this case series is the first case series in the English literature of the use of GLOA at the stellate ganglion for head-and-face pain.
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Reg Anesth Pain Med · Sep 2006
Ultrastructure of canine meninges after repeated epidural injection of S(+)-ketamine.
The safety of ketamine when administered by the spinal route must be confirmed in various animal species before it is approved for use in humans. This study evaluates the ultrastructure of canine meninges after repeated doses of epidural S(+)-ketamine. ⋯ Repeated doses of epidural S(+)-ketamine 5%, 1 mg/kg, twice a day for 10 days was not associated to cellular alterations in canine meninges.