Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2008
Comparative StudySonoanatomy of the lumbar spine in patients with previous unintentional dural punctures during labor epidurals.
Preprocedural lumbar ultrasound is a valuable tool to assess anatomical landmarks and predict the depth of the epidural space. Variations of the ligamentum flavum sonoanatomy are occasionally observed; however, no literature is available as to their incidence or clinical significance. We hypothesize that abnormal sonoanatomy of the lumbar spine detected by ultrasound can be associated with an increase in unintentional dural punctures. This study was undertaken to determine if the sonoanatomy of the lumbar spine of patients who had documented unintentional dural punctures differs from that of patients with a history of uneventful epidural placement for labor analgesia. ⋯ Abnormal sonoanatomy of the ligamentum flavum may represent anatomical variations of this structure, which may be related to an increased incidence of unintentional dural punctures during epidural placements.
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Reg Anesth Pain Med · May 2008
Contralateral neuropathic pain following a surgical model of unilateral nerve injury in rats.
Damage to peripheral nerves provokes chronic neuropathic pain that lasts beyond the duration of the nerve injury. The presence of pain signs have been reported in areas other than those attributed to the injured nerve, i.e., in contralateral regions. We evaluated the presence, magnitude, and chronology of mechanical and cold allodynia in the contralateral paw of rats undergoing unilateral ligation of the L5 and L6 spinal nerves. ⋯ After L5 and L6 spinal nerve ligation, rats developed mechanical and cold allodynia in the contralateral paw, suggesting extraterritorial development of neuropathic signs. This finding has implications for future study design and therapeutic approaches.
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Reg Anesth Pain Med · May 2008
Randomized Controlled Trial Comparative StudyThe effects of an epidural infusion of ropivacaine versus saline on sensory block after spinal anesthesia.
Several investigators have described the effect of bolus injections on sensory block during combined spinal epidural anesthesia. This study investigates the effects of the immediate epidural infusion of 0.2% ropivacaine versus 0.9% saline on spinal anesthesia. ⋯ Epidural infusion of ropivacaine 0.2% initiated immediately after spinal anesthesia prolonged the regression of motor block but not the regression of sensory block when compared with saline infusion.
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Reg Anesth Pain Med · May 2008
Randomized Controlled TrialUltrasound guidance improves the success of sciatic nerve block at the popliteal fossa.
Real time ultrasound guidance is a recent development in the area of peripheral nerve blockade. There are limited data from prospective randomized trials comparing its efficacy to that of traditional nerve localization techniques. In the present study, we tested the hypothesis that ultrasound guidance improves the success rate of sciatic nerve block at the popliteal fossa when compared with a nerve stimulator-guided technique. ⋯ Ultrasound guidance enhances the quality of popliteal sciatic nerve block compared with single injection, nerve stimulator-guided block using either a tibial or peroneal endpoint. Ultrasound guidance resulted in higher success, faster onset, and progression of sensorimotor block, without an increase in block procedure time, or complications.