Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2009
Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal.
Saphenous nerve (SN) block can be technically challenging because it is a small and exclusively sensory nerve. Traditional techniques using surface landmarks and nerve stimulation are limited by inconsistent success rates. This descriptive prospective study assesses the feasibility of performing an ultrasound-guided SN block in the distal thigh. ⋯ In this small descriptive study, ultrasound-guided SN block in the adductor canal was technically simple and reliable, providing consistent nerve identification and block success.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled Trial Multicenter Study Comparative StudyHemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.
Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. ⋯ Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled TrialThe transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery.
The transversus abdominis plane (TAP) block has been shown to provide analgesia for lower abdominal wall incisions. We evaluated the efficacy of the TAP block for post-cesarean delivery (CD) patients used as a part of a multimodal regimen. ⋯ The TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve the quality of post-CD analgesia.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled TrialKetorolac but not morphine exerts inflammatory and metabolic effects in synovial membrane after knee arthroscopy: a double-blind randomized prospective study using the microdialysis technique.
Our aim was to study local synovial metabolism, inflammation, and subjective pain scoring after intra-articular injection of morphine, ketorolac, or placebo in knee arthroscopy. ⋯ To our knowledge, this is the first study on the local metabolic and inflammatory effect of intra-articularly administered morphine or ketorolac. For the first time, glutamate was studied in synovial tissue, and our results suggest that local release of glutamate may be important for nociception and inflammation. The effects of ketorolac on PGE2 implicates a local effect on inflammation and possibly, also nociception, but it should be remembered that 60 mg of ketorolac given intra-articularly also has a systemic effect. Release of glycerol after administration of ketorolac may indicate a toxicity of nonsteroidal anti-inflammatory drugs that must be further evaluated.
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Reg Anesth Pain Med · Nov 2009
Minimum current requirements for epidural stimulation test confirmation of epidural and intrathecal catheter placement.
The typical blind insertion of a catheter into the epidural space risks catheter misplacement into the intrathecal space. The epidural stimulation test is designed to confirm the correct epidural location of a catheter but may also detect unintended intrathecal catheter placement by evaluating the minimum electrical current required for appropriate motor stimulation. Using this test, we observed the minimum current requirements for appropriate motor stimulation of catheters placed in the epidural and intrathecal spaces. ⋯ We conclude that the epidural stimulation test minimum electrical current requirement seems to be lower for intrathecal compared with epidural catheter placement.