Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyLong-term pain, stiffness, and functional disability after total knee arthroplasty with and without an extended ambulatory continuous femoral nerve block: a prospective, 1-year follow-up of a multicenter, randomized, triple-masked, placebo-controlled trial.
Previously, we have demonstrated that extending a continuous femoral nerve block (cFNB) from overnight to 4 days after total knee arthroplasty (TKA) provides clear benefits during the infusion, but not subsequent to catheter removal. However, there were major limitations in generalizing the results of that investigation, and we subsequently performed a very similar study using a multicenter format, with many health care providers, in patients on general orthopedic wards, thus greatly improving inference of the results to the general population. Not surprisingly, the perioperative/short-term outcomes differed greatly from the first, more limited study. We now present a prospective follow-up study of the previously published, multicenter, randomized controlled clinical trial to investigate the possibility that an extended ambulatory cFNB decreases long-term pain, stiffness, and functional disability after TKA, which greatly improves inference of the results to the general population. ⋯ This investigation found no evidence that extending an overnight cFNB to 4 days improves (or worsens) subsequent pain, stiffness, or physical function after TKA in patients of multiple centers convalescing on general orthopedic wards.
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Reg Anesth Pain Med · Mar 2011
Case ReportsIpsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block.
Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. ⋯ Brachial plexus block can occur by a route parallel to a nerve connecting the second intercostal nerve and T1 nerve, that is, Kuntz nerve. The hemidiaphragmatic paresis was attributed to the ascending spread of local anesthetic toward the area where the phrenic nerve bypasses the subclavian artery and vein.
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of neosaxitoxin versus bupivacaine via port infiltration for postoperative analgesia following laparoscopic cholecystectomy: a randomized, double-blind trial.
Wound infiltration with available local anesthetics generally provides analgesia for less than 8 hrs. The site 1 sodium-channel toxin neosaxitoxin (neoSTX) produced analgesia for over 24 hrs in animals and human volunteers. In this randomized, double-blind trial, we examined the postoperative course of patients undergoing laparoscopic cholecystectomy under a standardized general anesthesia with wound infiltration using either neoSTX or bupivacaine. We hypothesized that neoSTX would reduce pain compared with bupivacaine at 12 hrs postoperatively. ⋯ NeoSTX shows promise as a long-acting local anesthetic. Future studies will examine dose response, combination formulations, and safety with dose escalation.
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyCombined versus sequential injection of mepivacaine and ropivacaine for supraclavicular nerve blocks.
An ideal local anesthetic with rapid onset and prolonged duration has yet to be developed. Clinicians use mixtures of local anesthetics in an attempt to combine their advantages. We tested the hypothesis that sequential supraclavicular injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine speeds onset of sensory block and prolongs duration of analgesia compared with simultaneous injection of the same 2 local anesthetics. ⋯ Sequential injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine provides no advantage compared with simultaneous injection of the same doses.
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative Study Clinical TrialUltrasound guidance improves a continuous popliteal sciatic nerve block when compared with nerve stimulation.
Continuous sciatic nerve blockade at the popliteal level effectively alleviates postoperative pain after major foot and ankle surgery. No randomized controlled trials have previously compared the success rate of continuous sciatic nerve sensory blockade between ultrasound and nerve stimulation guidance. In the current study, we tested the hypothesis that ultrasound-guided catheter placement improves the success rate of continuous sciatic nerve sensory blockade compared with catheter placement with nerve stimulation guidance. ⋯ Ultrasound guidance used for sciatic catheter placement improves the success rate of sensory block, number of needle passes, patient satisfaction during catheter placement, and morphine consumption compared with nerve stimulation guidance.