Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2010
Randomized Controlled TrialPerioperative inflammatory response in total knee arthroplasty patients: impact of limb preconditioning.
Ischemic preconditioning of tissue that is to undergo procedure-induced underperfusion has been used in a number of surgical settings to reduce the subsequent inflammatory response and its sequelae. The objective of this prospective, randomized study was to evaluate the effect of ischemic preconditioning on the systemic inflammatory response, degree of lung catabolism, and postoperative-pain associated with total knee arthroplasty (TKA). ⋯ Preconditioning of the lower extremity in the setting of TKA under regional anesthesia may have limited value in reducing the systemic inflammatory response and level of lung injury. However, preconditioning may be associated with beneficial effects such as reduction in postoperative pain levels, and thus, further investigations are warranted.
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Reg Anesth Pain Med · Sep 2010
Randomized Controlled TrialDexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade.
Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. ⋯ The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.
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Reg Anesth Pain Med · Sep 2010
Case ReportsUltrasound-guided continuous phrenic nerve block for persistent hiccups.
Phrenic nerve block can be performed and repeated if necessary for persistent hiccups, when conservative and pharmacological treatment is unsuccessful. We report the first description of an in-plane ultrasound (US)-guided phrenic nerve block (PhNB) with a catheter, after US investigation of the bilateral diaphragm, to treat hiccups while avoiding repeated PhNBs. ⋯ An US-guided in-plane PhNB with catheter is feasible and avoids repeated PhNB when hiccups reoccur. Ultrasound investigation of the bilateral diaphragm should be performed before performing the nerve block.
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Reg Anesth Pain Med · Sep 2010
Perioperative pulmonary circulatory changes during bilateral total hip arthroplasty under regional anesthesia.
The transient and rarely clinically relevant effect of bone and cement embolization during unilateral joint arthroplasty is a known phenomenon. However, available studies do not address events surrounding bilateral total hip arthroplasties, during which embolic load is presumably doubled. To elucidate events surrounding this increasingly used procedure and assess the effect on the pulmonary hemodynamics in the intraoperative and postoperative periods, we studied 24 subjects undergoing cemented bilateral total hip arthroplasty during the same anesthetic session. ⋯ The embolization of material during bilateral total hip arthroplasty is associated with prolonged increases in pulmonary artery pressures and vascular resistance, particularly after completion of the second side. Performance of bilateral procedures should be cautiously considered in patients with diseases suggesting decreased right ventricular reserve.
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Reg Anesth Pain Med · Sep 2010
Subepineurial injection in ultrasound-guided interscalene needle tip placement.
The neural elements of the brachial plexus between the anterior and middle scalene muscles are readily visible by ultrasound. However, the epineurium of these nerve structures is difficult to discern on ultrasound imaging because of the proximity of the scalene muscles to the nerve elements, and this may lead to unintentional subepineurial injection (SEI). To evaluate whether typical needle tip placement under ultrasound guidance results in SEI, as opposed to extraneural injection, we undertook this cadaver study. ⋯ In a cadaver model of needle tip placement for ultrasound-guided interscalene block, we found that SEI occurred more frequently than expected.