Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2009
Meta AnalysisEfficacy of bicarbonate in decreasing pain on intradermal injection of local anesthetics: a meta-analysis.
Intradermal injection of local anesthetic often results in pain on injection due in part to the acidic pH of commercially prepared solutions, which are optimized to prolong shelf life. Although there are other possible explanations (eg, noxious properties of local anesthetics, pressure effect of infiltration), the etiology is most likely multifactorial. Although addition of bicarbonate to local anesthetics may decrease pain on intradermal injection, the extent of this analgesic effect is uncertain. We performed a meta-analysis of available trials investigating pain during intradermal injection of buffered local anesthetic preparations. ⋯ Our systematic review suggests that the use of buffered local anesthetics seems to be associated with a statistical decrease in pain of infiltration when compared with unbuffered local anesthetic.
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Reg Anesth Pain Med · Mar 2009
Randomized Controlled TrialContinuous femoral nerve block provides superior analgesia compared with continuous intra-articular and wound infusion after anterior cruciate ligament reconstruction.
This prospective, randomized, clinical trial compared pain intensity and analgesic drug consumption after anterior cruciate ligament (ACL) reconstruction with patellar tendon under femoral-sciatic nerve block anesthesia in patients who received either a continuous femoral nerve block (CFNB) or continuous local anesthetic wound and intra-articular infusions. ⋯ Continuous femoral nerve block provides better analgesia than the continuous patellar tendon wound and intra-articular infusions after anterior cruciate ligament reconstruction with patellar tendon.
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Reg Anesth Pain Med · Mar 2009
A prospective, observational study of the relationship between body mass index and depth of the epidural space during lumbar transforaminal epidural steroid injection.
Previous studies have concluded that transforaminal epidural steroid injections (ESIs) are more effective than interlaminar injections in the treatment of radiculopathies due to lumbar intervertebral disk herniation. There are no published studies examining the depth of epidural space using a transforaminal approach. We investigated the relationship between body mass index (BMI) and the depth of the epidural space during lumbar transforaminal ESIs. ⋯ There is a positive association between BMI and transforaminal epidural depth, but not with age, sex, race, oblique angle, or intervertebral level.
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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
A web-based cross-sectional epidemiological survey of complex regional pain syndrome.
Complex regional pain syndrome (CRPS) is a poorly understood pain disorder with little information on the natural course of the disease. Changes in its diagnostic criteria have simplified the identification of this syndrome, but convincing epidemiological data regarding this disorder are still lacking. Here, we collected epidemiological and other relevant information regarding CRPS via a Web-based survey to develop a better understanding of the epidemiology, symptoms, progression, therapy, and associated psychosocial factors related to CRPS. ⋯ Complex regional pain syndrome is a severe disabling pain disorder that results in physical as well as emotional and financial consequences to patients. The disease complexity requires coordination of multidisciplinary care that can be achieved by educational efforts directed to general practitioners.