Regional anesthesia and pain medicine
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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
Case ReportsFunctional deficits after intraneural injection during interscalene block.
We present an occurrence of a severe but transient neurologic complication after intraneural injection during an ultrasound-guided interscalene block. ⋯ Our report suggests that intraneural injection during ultrasound-guided interscalene block carries a risk of neurologic complications.
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Reg Anesth Pain Med · Jul 2010
Randomized Controlled Trial Comparative StudyProtein balance in nondiabetic versus diabetic patients undergoing colon surgery: effect of epidural analgesia and amino acids.
Surgical injury provokes a stress response that is thought to be pronounced in patients with diabetes mellitus type 2 (DM2) leading to intensified catabolism. The aim of this study was to compare the effects of perioperative epidural analgesia (EDA) versus patient controlled analgesia (PCA) and amino acid infusion on postoperative metabolism in patients with and without DM2. ⋯ A short-term infusion of amino acids reduced protein breakdown, increased protein synthesis, and rendered protein balance positive. This anabolic effect was pronounced in diabetic patients with EDA compared with nondiabetic patients or PCA, respectively, and prevented an undesirable hyperglycemia.