Regional anesthesia and pain medicine
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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.
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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.
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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.
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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
The effect of levosimendan on bupivacaine-induced severe myocardial depression in anesthetized pigs.
Levosimendan, an inodilator without proarrhythmogenic properties, has been shown to reverse ropivacaine-induced negative inotropy in isolated heart preparations. In this randomized and blinded study, we investigated whether levosimendan is able to reverse rapidly bupivacaine-induced myocardial depression in pigs. ⋯ Levosimendan together with the infusion of Ringer's solution rapidly reversed the cardiac depression, but there was no difference in overall cardiovascular recovery in comparison to treatment with Ringer's solution alone. Levosimendan-induced increase in heart rate possibly facilitated the recovery from bupivacaine intoxication.