Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2011
Comparative StudyMinimum effective volume of lidocaine for ultrasound-guided supraclavicular block.
The aim of this study was to determine the minimum effective volume of lidocaine 1.5% with epinephrine 5 μg/mL in 90% of patients (MEV90) for double-injection ultrasound-guided supraclavicular block (SCB). ⋯ For double-injection ultrasound-guided SCB, the MEV90 of lidocaine 1.5% with epinephrine 5 μg/mL is 32 mL. Further dose finding studies are required for other concentrations of lidocaine, other local anesthetic agents and single-injection techniques.
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Reg Anesth Pain Med · Sep 2011
Comparative StudyThe influence of adjuvants used in regional anesthesia on lidocaine-induced neurotoxicity in vitro.
Neurotoxic properties of local anesthetics can rarely lead to irreversible neuronal damage as in cauda equina syndrome. Clinically, local anesthetics are often combined with adjuvants to improve or prolong the anesthetic effect, whereas the impact of such adjuvants on lidocaine-induced apoptosis is unclear. Therefore, we investigated the influence of different adjuvants on the neurotoxicity of lidocaine. ⋯ Sufentanil, clonidine, epinephrine, and neostigmine do not influence the neurotoxicity of lidocaine in vitro. Morphine may have some cytoprotective effect at concentrations greater than those seen intrathecally in humans. In contrast, ketamine and midazolam increase the neurotoxicity of lidocaine in vitro, presumably by additive induction of mitochondrial apoptosis.
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Reg Anesth Pain Med · Sep 2011
Case ReportsRetained stimulating perineural catheters: a report of four cases.
As the use of ambulatory continuous peripheral nerve blocks continues to grow, new management issues will inevitably arise. Previous descriptions of difficult catheter removal due to cutting, knotting, or kinking of the catheter have involved inpatients. A series of retained ambulatory interscalene catheters has recently been reported. ⋯ Stimulating perineural catheters may be difficult to remove. This may be particularly problematic for outpatients removing the catheters at home.