Regional anesthesia and pain medicine
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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.
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyPosterior versus anterolateral approach interscalene catheter placement: a prospective randomized trial.
Two distinctly different approaches to interscalene catheter placement have been in common use for close to a decade. This prospective randomized study tested the hypothesis that interscalene catheters placed using the posterior approach would provide a more effective analgesia after shoulder surgery compared with catheters placed using the anterolateral approach. ⋯ Anterolateral interscalene catheters perform more effectively and are procedurally more easily placed compared with catheters placed using the posterior approach.
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Reg Anesth Pain Med · Mar 2011
ReviewMeralgia paresthetica: what an anesthesiologist needs to know.
Meralgia paresthetica (MP) is an entrapment pain syndrome of the lateral femoral cutaneous nerve (LFCN) of thigh. Diagnosis is principally made on clinical ground with pain and paresthesia of the anterolateral thigh. Electrophysiological test and nerve block play important roles when the diagnosis is uncertain. ⋯ Surgical options should be considered in patients refractory to those treatment options. Anesthesiologists are commonly involved in the management of MP because of their expertise in pain management and performance of the LFCN block. Blockade of the LFCN with local anesthetics and steroid serves both the diagnostic and therapeutic role.