Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2010
Randomized Controlled TrialLong-lasting analgesic effects of intraoperative thoracic epidural with bupivacaine for liver resection.
Continuous epidural analgesia may be considered in liver resection but is often avoided because of possible coagulopathies and the risk of epidural hematoma in the postoperative period. On the other hand, there is no coagulation defect during the surgery. Effective prevention of postoperative pain may require continuous sensory ablation throughout the surgery event. ⋯ Intraoperative thoracic epidural infusion of bupivacaine, added to intrathecal morphine, decreased postoperative morphine consumption with better pain relief compared with the placebo.
-
Reg Anesth Pain Med · Jan 2010
Randomized Controlled TrialAnalgesic effectiveness of a continuous versus single-injection interscalene block for minor arthroscopic shoulder surgery.
The utility of continuous perineural infusions for lesser painful shoulder procedures is not well established. We hypothesized that the addition of a continuous interscalene ropivacaine infusion to a single-injection interscalene block would improve analgesia after minor arthroscopic shoulder surgery. ⋯ After minor arthroscopic shoulder surgery, the addition of a continuous interscalene ropivacaine infusion to a single-shot interscalene block reduces pain, especially with movement, during the first 24 hrs.
-
Reg Anesth Pain Med · Jan 2010
Randomized Controlled Trial Comparative StudyAxillary block by "selective" injections at the nerves involved in surgery using a peripheral nerve stimulator: a comparison with a "standard" triple-injection technique.
A triple-injection technique (injections at the median, musculocutaneous, and radial nerves) for axillary block affords a high incidence of complete block (all the nerves below the elbow). However, in certain surgeries, only 1 or 2 nerves are involved in the surgical field. The aim of this prospective randomized study was to test the effectiveness of surgical anesthesia of a "selective" approach in which only the nerves involved in surgery were electrically located and injected. ⋯ A standard triple-nerve stimulation technique seems to be preferable to the selective approach even when a limited number of nerves are involved in the surgical field.
-
Reg Anesth Pain Med · Jan 2010
Comparative StudyNeedle-induced paresthesiae during single-shot spinal anesthesia: a comparison of sitting versus lateral decubitus position.
Paresthesiae occasionally occur during spinal puncture or injection of local anesthetic for spinal anesthesia. No information is currently available regarding the effects of the patient's position on the incidence of needle-induced paresthesiae. The purpose of this prospective, observational study was to compare the occurrence of needle-induced paresthesiae in patients who received single-shot spinal anesthesia in the sitting position or in the lateral decubitus position. ⋯ Patient's position may influence the occurrence of needle-induced paresthesiae during spinal anesthesia. Lateral decubitus position resulted in a higher incidence of paresthesiae than the sitting position. However, there is no position-related difference noted if a single-needle puncture is sufficient to perform the block.