Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2008
Randomized Controlled Trial Comparative StudyMedian effective local anesthetic doses of plain bupivacaine and ropivacaine for spinal anesthesia administered via a spinal catheter for brachytherapy of the lower abdomen.
Continuous spinal anesthesia via a spinal catheter allows adjusting the duration and extent of anesthesia to surgical needs, maintenance of hemodynamic stability, and good postoperative analgesia. This study was designed to determine the median effective local anesthetic dose of plain ropivacaine and bupivacaine administered intrathecally for interstitial brachytherapy of the lower abdomen using the Dixon up-and-down method. ⋯ Bupivacaine and ropivacaine are appropriate for continuous spinal anesthesia for interstitial radiation therapy procedures of the lower abdomen. In the dose-ranges investigated, intrathecal ropivacaine is approximately half as potent as bupivacaine.
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Reg Anesth Pain Med · Jan 2008
Randomized Controlled TrialEffect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer.
Surgical stress and general anesthesia suppress immune function. Preemptive epidural analgesia can affect the perioperative immune responses, and influence cancer management. ⋯ Preemptive epidural analgesia is a reasonable approach for potentially controlling perioperative immune function and preventing postoperative pain in patients undergoing cancer surgery.
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Reg Anesth Pain Med · Jan 2008
Randomized Controlled TrialUse of a topical anesthetic cream (EMLA) to reduce pain after hemorrhoidectomy.
Hemorrhoidectomy usually leads to severe postoperative pain that often causes urinary retention. Topical EMLA cream (lidocaine 2.5% and prilocaine 2.5%) has been used extensively in the clinical setting. This prospective study tested the effectiveness of EMLA cream for postoperative pain control after hemorrhoidectomy. ⋯ Topical EMLA cream decreased pain intensity and meperidine requests, reduced the frequency of single catheterizations, and improved patient satisfaction with postoperative pain management after hemorrhoidectomy in adults.
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Reg Anesth Pain Med · Jan 2008
Case ReportsUltrasound-guided brachial plexus block in a patient with multiple glomangiomatosis.
Glomangiomas are rare, vascular tumors consisting of an afferent artery, arteriovenous canal, neuro-reticular elements, collagen, and efferent veins, and are most often located in the soft tissue of the upper extremities. We describe how the use of ultrasound-guided nerve blockade altered the anesthetic management of a patient with multiple glomangiomatosis undergoing elective forearm surgery. ⋯ Although multiple glomangiomatosis is a rare disease, this case illustrates the invaluable contribution that ultrasound has made to modern, regional anesthetic practice, especially for patients with aberrant anatomy in whom traditional nerve-localization techniques could result in serious complications.
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Major nerves and vessels run alongside each other in a "neurovascular bundle" kept together by connective tissue that is often referred to by anatomists, surgeons, and anesthesiologists as the "sheath." Our goal was to macroscopically demonstrate the brachial plexus sheath in embalmed and fresh cadaver dissections. ⋯ We observed a macroscopic fibrous structure surrounding the plexus, which was filled with loose connective tissue lacking any apparent organization.