Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialSupraspinal pupillary effects of intravenous and epidural fentanyl during isoflurane anesthesia.
Epidural fentanyl has been shown to gain rapid access to the circulation resulting in supraspinal effects. We compared the supraspinal effects of fentanyl via epidural versus intravenous (IV) routes, during isoflurane anesthesia. Supraspinal fentanyl effect was evaluated as a reduction of pupillary reflex dilation (PRD) measured with infrared pupillometry. ⋯ Supraspinal effects of epidural fentanyl can be assessed during general anesthesia using infrared pupillometry. Epidural fentanyl 3 microg/kg produces significant but variable supraspinal effects during 0.5 minimum alveolar concentration isoflurane anesthesia.
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Reg Anesth Pain Med · Jan 2000
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia in labor: the addition of clonidine to bupivacaine-fentanyl.
Epidural clonidine has not been evaluated as a component of patient-controlled epidural analgesia (PCEA) solutions during labor. A randomized, double-blind trial was conducted to investigate the efficacy and side effects of PCEA using bupivacaine and fentanyl, with or without clonidine. ⋯ The addition of clonidine to epidural bupivacaine and fentanyl for PCEA in labor improved analgesia, reduced the supplementation rate, and reduced shivering. Increased sedation and lower BP were not clinically important.
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Reg Anesth Pain Med · Nov 1999
Randomized Controlled Trial Clinical TrialContinuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures.
The perioperative use of continuous psoas compartment block (CPCB) was compared with traditional pain management for patients with fracture of the femur. The anatomy of CPCB was also tested in cadavers. ⋯ The CPCB seems to be an appropriate technique for efficient and safe perioperative pain control. However, in our dissections, the psoas compartment was not well defined in all patients, thus, using this route for anesthesia may result in only partial success.
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Reg Anesth Pain Med · Nov 1999
Randomized Controlled Trial Clinical TrialIntravenous lidocaine, amantadine, and placebo in the treatment of sciatica: a double-blind, randomized, controlled study.
Sciatica is a neuropathic pain syndrome caused by compression and/or inflammation of spinal nerve roots by herniated disc material, and its treatment is therefore usually aimed at reducing compression and inflammation. Studies have shown that both systemic local anesthetics and N-methyl-D-aspartate (NMDA) receptor antagonists may produce analgesia in a variety of neuropathic pain syndromes. The present study evaluated the analgesic efficacy of i.v. infusions of the local anesthetic lidocaine, the NMDA receptor antagonist amantadine, and a placebo in sciatica. ⋯ Intravenous lidocaine, rather than amantadine, reduces both spontaneous and evoked sciatic pain.
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Reg Anesth Pain Med · Nov 1999
Randomized Controlled Trial Clinical TrialDouble-injection method using peripheral nerve stimulator is superior to single injection in axillary plexus block.
Axillary block using a single-injection method does not always provide effective analgesia. This study examined whether a double axillary block injection technique is superior to a single injection axillary block. ⋯ A double-injection method in axillary block provides excellent analgesia and motor block compared with a single-injection method. Moreover, the need for supplemental nerve blocks is significantly decreased.