Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2015
Case ReportsPain Management With Bilateral Continuous Thoracic Paravertebral Block in a Patient With Fontan-Associated Hepatocellular Carcinoma Undergoing Hepatectomy.
We report a case of perioperative management of a single-ventricle patient with Fontan-associated liver disease undergoing hepatectomy. ⋯ An analgesic regimen including thoracic PVB resulted in a rapid recovery without opioid-related side effects and early reinitiation of anticoagulation therapy. Our case illustrates the effective application of thoracic PVB in congenital heart disease patients for non-cardiac-related surgery.
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Reg Anesth Pain Med · Nov 2015
Case ReportsManagement of a Rare Complication of Epidural Analgesia in an Obese Laterally Positioned Parturient: Catheter Entrapment Next to the Inferior Vena Cava.
Intravascular, subdural, intrathecal, and subcutaneous placement of epidural catheters are known complications and common causes of anesthesia and analgesia failure. Because the epidural space is located near the retroperitoneum and catheters are placed blindly, it is possible that misplacement could involve other structures, including the inferior vena cava, the aorta, and the lumbar plexus. We report a case of an obese laterally positioned parturient who presented with an epidural catheter lodged in the retroperitoneum. ⋯ Conventional removal techniques were unsuccessful, and the catheter was finally removed after insertion of a guide wire under fluoroscopy. We conclude that obesity and lateral positioning are factors that increase the risk of epidural catheter misplacement, and a large distance from skin to loss of resistance is a potential sign of misplacement. We recommend ultrasound imaging to aid in the insertion of epidural catheters in high-risk patients.
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Reg Anesth Pain Med · Nov 2015
Ultrasound-Guided Approach for L5 Dorsal Ramus Block and Fluoroscopic Evaluation in Unpreselected Cadavers.
Medial branch blocks are frequently performed to diagnose lumbar facet-joint-mediated pain. Ultrasound guidance can increase practicability and eliminate exposure to ionizing radiation when compared with fluoroscopy. However, ultrasound-guided L5 dorsal ramus block, which, together with L4 medial branch block is necessary to anesthetize the most commonly affected facet joint L5/S1, has not been described so far. The objective of this study was to develop a technique and to evaluate its accuracy with standard fluoroscopy in unpreselected cadavers. ⋯ This is the first study to show that ultrasound-guided L5 dorsal ramus block is accurate and feasible in the absence of significant spondylolisthesis when performed with an oblique out-of-plane technique.
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Reg Anesth Pain Med · Nov 2015
Case ReportsUnilateral Transversus Abdominis Plane Block Catheter for the Treatment of Abdominal Wall Pain in Pregnancy: A Case Report.
The transversus abdominis plane (TAP) block anesthetizes the anterior branches of spinal nerves that innervate the abdominal wall from T6 to L1 dermatomes and provide effective postoperative analgesia after abdominal surgery. Several applications of TAP catheters are described for both acute and chronic abdominal wall pain, but there are no reported cases of TAP catheters used during pregnancy. ⋯ A TAP catheter inserted under ultrasound guidance can be effective for the treatment of chronic abdominal pain during pregnancy and may provide an alternative analgesic modality when intravenous opioids are not providing relief or when neuraxial analgesia techniques are not feasible or contraindicated.
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Reg Anesth Pain Med · Nov 2015
Population Pharmacokinetics of Amitriptyline After Intrathecal, Epidural, and Intravenous Administration in Sheep.
Amitriptyline (AMI) is a lipophilic, tricyclic antidepressant with analgesic properties that could potentially be used for epidural (EPI) analgesia. However, no pharmacokinetic data are available for AMI in spinal spaces. The objective of this study was to evaluate the spinal disposition and intrathecal (IT) bioavailability of AMI after IT and EPI administration. ⋯ Simultaneous population analysis for AMI demonstrated differences in EPI and IT pharmacokinetics following the EPI and IT administration of this drug. The IT bioavailability of AMI after EPI administration is relatively low.