Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Multicenter Study Comparative StudyEffect on neurostimulation of injectates used for perineural space expansion before placement of a stimulating catheter: normal saline versus dextrose 5% in water.
We clinically assessed the electrophysiologic effect of dextrose 5% in water (D5W) and of normal saline (NS) used for expansion of the perineural space before placing a stimulating catheter. We questioned if higher current was required with NS but not with D5W, as has been observed experimentally. ⋯ The current needed to electrostimulate the femoral or sciatic nerve was higher after injection of NS than after D5W.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyA comparison of sensory and motor loss after a femoral nerve block conducted with ultrasound versus ultrasound and nerve stimulation.
Controversy exists regarding the need for nerve stimulation when performing an ultrasound (US)-guided peripheral nerve block. We tested the hypothesis that the quality of a femoral nerve block (FNB) performed with US is equivalent to an FNB performed with US and nerve stimulation. ⋯ The addition of nerve stimulation to a US-guided FNB did not change preoperative block efficacy.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled TrialDoes local anesthetic dilution influence the clinical effectiveness of multiple-injection axillary brachial plexus block?: a prospective, double-blind, randomized clinical trial in patients undergoing upper limb surgery.
The relationship between the dose, volume, and concentration of local anesthetic and the quality and success of regional anesthesia remains unclear. Our aim was to test whether using 3 different volumes of the same local anesthetic dose influences the success rate of an axillary brachial plexus block with a multiple-injection technique in patients undergoing upper limb surgery. ⋯ An axillary brachial plexus block induced with a multiple-injection technique with mepivacaine 400 mg yields a high success rate regardless of the volume of anesthetic injected.
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Reg Anesth Pain Med · Sep 2009
Comparative StudyDevelopment and validation of a new technique for ultrasound-guided stellate ganglion block.
Although the stellate ganglion is located anteriorly to the first rib, anesthetic block is routinely performed at the C6 level. Ultrasonography allegedly improves accuracy of needle placement and spread of injectate. The technique is relatively new, and the optimal approach has not been determined. Moreover, the location of the cervical sympathetic trunk relative to the prevertebral fascia is debatable. ⋯ This study revealed that, at the C6 level, the cervical sympathetic trunk lies entirely subfascially. Subfascial injection via the lateral approach ensures reliable spread of a solution to the stellate ganglion.
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Reg Anesth Pain Med · Sep 2009
Controlled Clinical TrialParietal analgesia decreases postoperative diaphragm dysfunction induced by abdominal surgery: a physiologic study.
The postoperative analgesic strategy may influence the magnitude of the postoperative diaphragmatic dysfunction (PODD) induced by abdominal surgery. The purpose of this physiologic study was to evaluate the effect of continuous preperitoneal wound infusion (CPWI) of ropivacaine on PODD after open colorectal surgery. ⋯ Parietal analgesia delivered via a CPWI of ropivacaine reduces PODD induced by open colorectal surgery.