Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2009
Randomized Controlled Trial Comparative StudyComparison of 3 intensities of stimulation threshold for brachial plexus blocks at the midhumeral level: a prospective, double-blind, randomized study.
We conducted this prospective randomized study to compare the success rate and the onset time between 3 intensities of stimulation threshold (<0.5, 0.5-0.64, and 0.65-0.8 mA) when using a peripheral nerve stimulation at the midhumeral level. ⋯ We conclude that intensity of stimulation influenced onset time and success rate.
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Reg Anesth Pain Med · Jul 2009
Randomized Controlled Trial Multicenter StudyExtended-release epidural morphine (DepoDur) following epidural bupivacaine in patients undergoing lower abdominal surgery: a randomized controlled pharmacokinetic study.
The primary objective was to compare the serum pharmacokinetic profile of a single dose of extended-release epidural morphine (EREM) administered alone versus 15 to 60 mins after an analgesic epidural dose of bupivacaine. ⋯ The pharmacokinetic and efficacy profiles of a single 15-mg dose of EREM were not significantly altered when administered 15, 30, or 60 mins after an analgesic epidural dose of bupivacaine.
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Reg Anesth Pain Med · Jul 2009
Review Case ReportsRetained intrathecal catheter fragment after spinal drain insertion.
The placement of lumbar spinal drains is being done with increasing frequency to facilitate high-risk surgical procedures. One risk associated with these procedures is catheter shearing, resulting in a retained foreign body in the intrathecal space. Unlike retained epidural fragments, there are no guidelines on the management of this complication. The purpose of this article was to synthesize the literature on this subject to come up with guidelines for preventing and managing this complication. ⋯ A retained intrathecal catheter can be managed conservatively in certain contexts. Periodic follow-up visits, with or without repeat imaging, are recommended in these circumstances.
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Reg Anesth Pain Med · Jul 2009
Randomized Controlled Trial Comparative StudyComparison of the transarterial axillary block and the ultrasound-guided infraclavicular block for upper extremity surgery: a prospective randomized trial.
The transarterial axillary block and the ultrasound-guided infraclavicular block are both effective methods of anesthetizing the upper extremity. This study compares these methods with respect to subjective postoperative dysesthesias, block adequacy, patient comfort, and patient satisfaction. ⋯ There is no significant difference between the 2 techniques in terms of adequacy for surgery and subjective postoperative dysesthesias. The ultrasound-guided infraclavicular block is associated with greater patient comfort and willingness to undergo the same anesthetic when compared with the transarterial axillary block.
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Reg Anesth Pain Med · Jul 2009
Randomized Controlled Trial Comparative StudyIs ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block?
In different peripheral nerve blocks, it has been speculated that needle guidance by ultrasound improves onset time and success rate compared with the more frequently used nerve stimulation-guided technique. In the present study, we tested the hypothesis that ultrasound guidance improves onset time of coracoid infraclavicular brachial plexus block (IBPB) when compared with a nerve stimulation-guided technique. ⋯ The present investigation demonstrates that ultrasound guidance and nerve stimulation provide similar onset time, success rate, and duration of motor blockade for coracoid IBPB; however, ultrasound guidance reduces the time required to perform the block.