Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2010
Practice GuidelineRegional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition).
The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics, recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient populations. Overall, the risk of clinically significant bleeding increase with age,associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement,and an indwelling neuraxial catheter during sustained anticoagulation( particularly with standard heparin or low-molecular weight heparin). ⋯ As a result,the ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation. These are based on case reports, clinical series, pharmacology,hematology, and risk factors for surgical bleeding. An understanding of the complexity of this issue is essential to patient management.
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Reg Anesth Pain Med · Jan 2010
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison between single- and double-injection ultrasound-guided infraclavicular brachial plexus block.
This prospective, randomized, observer-blinded study compared single- and double-injection ultrasound-guided infraclavicular brachial plexus block for upper extremity surgery. ⋯ The double-injection ultrasound-guided infraclavicular block provides no significant advantages compared with its single-injection counterpart.
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Reg Anesth Pain Med · Jan 2010
The efficiency of pulsed radiofrequency application on L5 and l6 dorsal roots in rabbits developing neuropathic pain.
Injury of a peripheral nerve may lead to neuropathic pain, a form of chronic pain that does not respond to traditional pain therapies. The aim of this study was to investigate the effect of pulsed radiofrequency (PRF) applied to the L5 and L6 dorsal roots on the neuropathic pain that develops after sciatic nerve injury in rabbits. ⋯ The hyperalgesia that develops as a result of neuropathic pain in rabbits was observed to be reduced by PRF application.