Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program.
Laparoscopy, thoracic epidural analgesia, and enhanced recovery program (ERP) have been shown to be the major elements to facilitate the postoperative recovery strategy in open colorectal surgery. This study compared the effect of intraoperative and postoperative intravenous (IV) lidocaine infusion with thoracic epidural analgesia on postoperative restoration of bowel function in patients undergoing laparoscopic colorectal resection using an ERP. ⋯ Intraoperative and postoperative IV infusion of lidocaine in patients undergoing laparoscopic colorectal resection using an ERP had a similar impact on bowel function compared with thoracic epidural analgesia.
-
Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative StudyComparison of continuous thoracic epidural with paravertebral block on perioperative analgesia and hemodynamic stability in patients having open lung surgery.
Epidural analgesia can result in perioperative hypotension in patients having thoracotomy. This randomized prospective study assessed the effects of epidural and paravertebral analgesia on hemodynamics during thoracotomy. ⋯ Under the conditions of our study, continuous paravertebral block resulted in similar analgesia but greater hemodynamic stability than epidural analgesia in patients having thoracotomy. Paravertebral block also required smaller volume of colloids and vasopressors to maintain the target oxygen delivery index (DO2I).
-
Reg Anesth Pain Med · May 2011
Comparative StudyTransient heat hyperalgesia during resolution of ropivacaine sciatic nerve block in the rat.
Preliminary studies using perineural sciatic ropivacaine in rat demonstrated unexpected heat hyperalgesia after block resolution. To better characterize the time course relative to mechanical anesthesia-analgesia, we tested the hypothesis that ropivacaine 0.5% leads to transient heat hyperalgesia in rats independent of mechanical nociception. We also evaluated functional toxicity (eg, long-term hyperalgesia and/or tactile allodynia 2 weeks after injection). ⋯ Ropivacaine 0.5% induces transient heat hyperalgesia in the setting of resolved mechanical analgesia, further suggestive of modality and/or nociceptive fiber specificity. Whether this finding partially translates to "rebound pain" after patients' nerve blocks wear off requires further study.
-
Reg Anesth Pain Med · May 2011
Comparative StudyMorphologic study of nerve root and types of needle used in transforaminal injections.
The bevel type and location of the distal orifice of the needle may have relevance for potential complications occurring during transforaminal epidural injection. ⋯ The layer of fat around nerve roots may prevent the contact of the needle tip with axons. The sharp needle tip entered the nerve root cuff more easily than the blunt tip in the cadaveric nerve root samples, measured in a qualitative manner. There is a need for clinical studies to ascertain if blunt needles may be safer than sharp needles for transforaminal injections.