Regional anesthesia and pain medicine
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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 Trial Comparative StudyA prospective randomized comparison of ultrasound guidance versus neurostimulation for interscalene catheter placement.
Ultrasound (US) imaging facilitates catheter placement adjacent to the most appropriate elements of the brachial plexus, which for shoulder surgery are the C5YC6 roots or superior trunk. Therefore, it was investigated whether such placement would improve catheter effectiveness compared to placement with traditional techniques. ⋯ After shoulder surgery, interscalene catheters placed with US demonstrated improved effectiveness during the first 24 hrs compared with those placed with NS. These catheters were also placed with less needling and a very small reduction in procedure-related pain.
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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
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.