Regional anesthesia and pain medicine
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Spinal ultrasound offers valuable information to facilitate the placement of lumbar neuraxial anesthesia. Lumbar spine sonograms are unique, and aspects may appear atypical at times, particularly the ligamentum flavum (LF). The objective of this study was to describe the sonoanatomy of the lumbar spine and to determine the frequency of atypical images of the LF in pregnant women at term. ⋯ The paramedian longitudinal sonograms of the lumbar spine are of superior quality to those obtained in the transverse plane. When using the transverse approach, a high incidence of inconclusive sonograms should be expected in the lower segments. The incidence of atypical LF images, especially in the upper lumbar segments, warrants further investigation because it can have implications for the epidural technique.
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Reg Anesth Pain Med · Nov 2009
Comparative StudyRedistribution of tissue blood flow after stellate ganglion block in the rabbit.
The goal of this study was to compare tissue blood flow at various sites before and after stellate ganglion block (SGB) and to discuss the redistribution of tissue blood flow after SGB. ⋯ These results indicate that lower limb and visceral blood flow as well as blood flow on the nonblock side are redistributed to the block side after SGB. Redistribution from peripheral tissue may have a more important role than that of visceral blood flow redistribution after SGB.
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Reg Anesth Pain Med · Nov 2009
Effects of dexmedetomidine pretreatment on bupivacaine cardiotoxicity in rats.
We evaluated the effects of dexmedetomidine pretreatment on bupivacaine cardiotoxicity in anesthetized rats. ⋯ Dexmedetomidine pretreatment delays the effects of bupivacaine cardiotoxicity.
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Reg Anesth Pain Med · Nov 2009
Pain: friend or foe? A Neurobiologic perspective: the 2008 Bonica Award Lecture.
Pain is a protective sensation, but it can also be a burden without any useful value. Pain as a friend warns of impending damage and protects the body from injury. Pain as a foe is a useless sensation that makes the underlying problem worse and becomes a disease in its own right. ⋯ However, in inflammatory and neuropathic conditions, these actions are reversed, leading to touch-evoked pain or tactile allodynia. The mechanism responsible for this reversal is a change in the synaptic actions of [gamma]-aminobutyric acid that switches from being an inhibitory neurotransmitter to an excitatory one. Our challenge was to devise methods for pain relief based on elimination of the useless aspects of pain and the restoration of the protective qualities of normal pain sensation.