Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2009
Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases.
Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery. ⋯ Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.
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Reg Anesth Pain Med · Mar 2009
Hydrodynamics of the spinal epidural space in pigs: effects of death and exsanguinations.
We have investigated how the vascular components of the spine determine the resistance and capacitance of the spinal epidural space and determined the magnitude of the longitudinal pressure gradient in the space during fluid infusion. ⋯ There is a small longitudinal pressure gradient within the epidural space during fluid infusion. Hence, the major source of resistance occurs where fluid leaves the epidural space. Death reduced resistance, perhaps by depressurizing spinal arteries in the intervertebral foramina, but did not affect capacitance. Blood in epidural veins is a major determinant of late epidural capacitance.
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Reg Anesth Pain Med · Mar 2009
Randomized Controlled TrialA comparison between EMLA cream application versus lidocaine infiltration for postoperative analgesia after inguinal herniotomy in children.
EMLA cream (eutectic mixture of local anesthetics) has been shown to penetrate intact skin and provide analgesia of superficial layers. There are no studies on the effects of topical application of EMLA cream for postoperative pain relief after inguinal hernia repair. ⋯ Topical application of EMLA (5%) provides postoperative analgesia comparable to infiltration with 1% lidocaine after inguinal hernia repair in children.
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Reg Anesth Pain Med · Mar 2009
Randomized Controlled TrialKetamine as an adjuvant in lidocaine intravenous regional anesthesia: a randomized, double-blind, systemic control trial.
Ketamine delays and minimizes intraoperative tourniquet pain when added to lidocaine-based intravenous regional anesthesia (IVRA). It is unclear if adding ketamine to the IVRA injectate is more efficacious compared with systemic administration. This study compares intraoperative tourniquet pain, postoperative analgesia, and side effects of systemic versus IVRA ketamine during outpatient hand surgery. ⋯ In comparison to systemic administration, there is no selective benefit to adding ketamine to the IVRA injectate.