Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled Trial Comparative StudyA Randomized Comparison of the Efficacy of 2 Techniques for Piriformis Muscle Injection: Ultrasound-Guided Versus Nerve Stimulator With Fluoroscopic Guidance.
Piriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques. ⋯ Ultrasound-guided piriformis injections provide similar outcomes to fluoroscopically guided injections without differences in imaging, needling, or overall procedural times.
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Reg Anesth Pain Med · Mar 2014
Case ReportsAdductor canal block can result in motor block of the quadriceps muscle.
The block of nerves in the adductor canal is considered to cause a sensory block without a motor component. In this report, we describe a case of significant quadriceps muscle weakness after an adductor canal block (ACB). ⋯ Several studies have reported that ACB involves no motor blockade. However, our case report illustrates that the ACB can result in clinically significant quadriceps muscle paralysis. This report suggests that patients should be monitored vigilantly for this occurrence to decrease the risk of falls.
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialMinimum Effective Volume of Combined Lidocaine-Bupivacaine for Analgesic Subparaneural Popliteal Sciatic Nerve Block.
The aim of this study was to determine the minimum effective volume (MEV) of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL in 90% of patients (MEV90) for ultrasound-guided subparaneural popliteal sciatic nerve block. ⋯ For ultrasound-guided subparaneural (analgesic) popliteal sciatic nerve block, the MEV90 of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL is 13.3 mL (95% confidence interval, 10.2-16.4 mL).
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Reg Anesth Pain Med · Mar 2014
Multicenter Study Comparative StudyDoes the Impact of the Type of Anesthesia on Outcomes Differ by Patient Age and Comorbidity Burden?
Neuraxial anesthesia may provide perioperative outcome benefits versus general anesthesia in orthopedic surgical patients. As subgroup analyses are lacking, we evaluated the influence of the type of anesthesia on outcomes in patient groups of different age and the presence of cardiopulmonary disease. ⋯ Neuraxial anesthesia is associated with decreased odds for major complications and resource utilization after joint arthroplasty for all patient groups, irrespective of age and comorbidity burden.
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialEndogenous opioid inhibition of chronic low-back pain influences degree of back pain relief after morphine administration.
Factors underlying differential responsiveness to opioid analgesic medications used in chronic pain management are poorly understood. We tested whether individual differences in endogenous opioid inhibition of chronic low-back pain were associated with the magnitude of acute reductions in back pain ratings after morphine administration. ⋯ Morphine appears to provide better acute relief of chronic back pain in individuals with lower natural opioidergic inhibition of chronic pain intensity. Possible implications for personalized medicine are discussed.