Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyTriple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block.
Practitioners mix faster-onset, intermediate-duration local anesthetics (LAs) with slower-onset, long-duration LAs to get fast peripheral nerve block (PNB) onset and long duration. We hypothesized that 1.5% mepivacaine (with epinephrine) (mepivacaine) or 1.5% mepivacaine (with epinephrine) mixed with 0.5% bupivacaine (mixed) would reduce PNB sensory onset by 20% or more versus 0.5% bupivacaine alone (bupivacaine). ⋯ Mixing 1.5% mepivacaine (with epinephrine) with 0.5% bupivacaine speeds up PNB sensory (motor) onset compared with 0.5% bupivacaine alone.
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Reg Anesth Pain Med · Jan 2012
Comparative StudyBeyond repeated-measures analysis of variance: advanced statistical methods for the analysis of longitudinal data in anesthesia research.
Research in the field of anesthesiology relies heavily on longitudinal designs for answering questions about long-term efficacy and safety of various anesthetic and pain regimens. Yet, anesthesiology research is lagging in the use of advanced statistical methods for analyzing longitudinal data. The goal of this article was to increase awareness of the advantages of modern statistical methods and promote their use in anesthesia research. ⋯ Based on their advantages over RM-ANOVA, GEE and MEM should be strongly considered for the analysis of longitudinal data. In particular, GEE should be used to explore overall average effects, and MEM should be used when subject-specific effects (in addition to overall average effects) are of primary interest.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyComparison of a single- or double-injection technique for ultrasound-guided supraclavicular block: a prospective, randomized, blinded controlled study.
Despite good success rates reported with ultrasound-guided supraclavicular block using 1 or multiple injections, no consensus exists on the best technique to use. We designed this study to test the hypothesis that a double-injection technique would hasten the onset of sensory block. ⋯ The double-injection technique offers no benefit over a single injection for the performance of an ultrasound-guided supraclavicular block.
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Reg Anesth Pain Med · Jan 2012
ReviewBeyond opioid patient-controlled analgesia: a systematic review of analgesia after major spine surgery.
Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. ⋯ The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.