Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled TrialLess urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia.
It is common practice to catheterize the bladder in the presence of epidural analgesia and to leave the bladder catheter in situ to avoid postoperative urinary retention. However, bladder catheterization carries the risk for urinary tract infection (UTI). The objective of this randomized control trial was to assess whether the incidence of UTI will differ among patients receiving standard care and patients who have the bladder catheterization discontinued on the morning after surgery with the epidural still functioning. ⋯ Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations.
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Reg Anesth Pain Med · Nov 2009
Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications.
Peripheral nerve blockade is associated with excellent patient outcomes after surgery; however, neurologic and other complications can be devastating for the patient. This article reports the development and preliminary results of a multicenter audit describing the quality and safety of peripheral nerve blockade. ⋯ These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade.
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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.