Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2010
Comparative StudyThe effect of fluid injection on lesion size during radiofrequency treatment.
Previous ex vivo studies on monopolar radiofrequency have not incorporated the preinjection of fluid before radiofrequency ablation into study design. The objective of this study was to investigate the effects of the preinjection of small volumes of different fluids on lesion dimensions. ⋯ The influence of the composition of the pre-injected fluid should be considered for monopolar radiofrequency ablation. This ex vivo study revealed a simple method to increase monopolar radiofrequency lesion size. Future research is needed to determine the degree of influence of the composition of the fluid on thermal and electrical conductivity.
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Reg Anesth Pain Med · Jul 2010
The anatomy of the thoracic spinal canal in different postures: a magnetic resonance imaging investigation.
The goal of this study was to investigate,with magnetic resonance imaging, the human anatomic positions of the spinal canal (eg, spinal cord, thecal tissue) in various postures and identify possible implications from different patient positioning for neuraxial anesthetic practice. ⋯ The spinal cord follows the straightest line through the imposed geometry of the spinal canal. Accordingly, there is relatively more posterior separation of the cord and surrounding thecal tissue at midthoracic levels in the apex of the thoracic kyphosis. Placing a patient in a position that accentuates the thoracic curvature of the spine (ie,sitting head-down) increases the posterior separation of the spinal cord and dural sheath at thoracic levels.
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Reg Anesth Pain Med · Jul 2010
Prospective survey of patient-controlled epidural analgesia with bupivacaine and hydromorphone in 3736 postoperative orthopedic patients.
Patient-controlled epidural analgesia(PCEA) has been shown to be superior to intravenous patient-controlled analgesics (PCA) for postoperative analgesia after thoracic, abdominal, pelvic, and lower extremity surgery. However, it is unclear which opioid is optimal for PCEA. Hydromorphone has potential advantages, yet there are no data to establish its efficacy and safety. Thus, we prospectively monitored our patients receiving PCEA with bupivacaine combined with hydromorphone after orthopedic surgery. ⋯ Patient-controlled epidural analgesia with bupivacaine and hydromorphone provides effective and safe postoperative analgesia for orthopedic surgery.
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Reg Anesth Pain Med · Jul 2010
Local anesthetic sciatic nerve block and nerve fiber damage in diabetic rats.
A concern for anesthesiologists is whether local anesthetics are more toxic to peripheral nerves in diabetic patients. A previous study in streptozotocin-induced diabetic rats showed that larger doses of lidocaine produce moderate nerve injury after nerve block in normal rats and worse injury in diabetic rats. However, it is not clear whether a smaller local anesthetic dose that produces negligible nerve fiber damage in normal rats will produce significant nerve damage in diabetic rats and if adding adjuvant drugs modulates this effect. ⋯ The duration of sciatic nerve block with local anesthetics is longer in diabetic compared with nondiabetic rats. A small, but statistically significant, increase in nerve damage occurred in diabetic rats after nerve block with ropivacaine alone or when duration of lidocaine block was extended with clonidine. These findings may have implications for dosing of local anesthetics in diabetic patients undergoing regional analgesia with nerve blocks.
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Reg Anesth Pain Med · Jul 2010
Case ReportsNerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block.
Neurologic complications after peripheral nerve blocks (PNBs) are relatively uncommon. It has been postulated that real-time, needle-nerve visualization during ultrasound guided PNBs might further reduce the risk of neurologic or vascular complications. ⋯ Ultrasound guidance should not preclude development of additional monitoring and protocols to decrease the risk of complications with PNBs.