Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2013
Randomized Controlled Trial Comparative StudyUltrasound-guided popliteal block through a common paraneural sheath versus conventional injection: a prospective, randomized, double-blind study.
The macroscopic anatomy of a common paraneural sheath that surrounds the sciatic nerve in the popliteal fossa has been studied recently in a human cadaveric study. It has been suggested that an injection through this sheath could be an ideal location for local anesthetic administration for popliteal block. The aim of the present study was to evaluate the hypothesis that popliteal sciatic nerve blockade through a common paraneural sheath results in shorter onset time when compared with conventional postbifurcation injection external to the paraneural tissue. To illustrate the microscopic anatomy of the paraneural tissues, we performed histological examinations of a human leg specimen. ⋯ An ultrasound-guided popliteal sciatic nerve block through a common paraneural sheath at the site of sciatic nerve bifurcation is a simple, safe, and highly effective block technique. It results in consistently short onset time, while respecting the integrity of the epineurium and intraneural structures.
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Reg Anesth Pain Med · May 2013
Randomized Controlled Trial Comparative StudyA randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block.
Third occipital nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial, we compared the 2 imaging modalities. Our research hypothesis was that US guidance would result in a shorter performance time. ⋯ Fluoroscopy and US guidance provide similar success rates for TONB. However, ultrasonography is associated with improved efficiency (decreased performance time, fewer needle passes).
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Reg Anesth Pain Med · Mar 2013
Randomized Controlled TrialA prospective, randomized, blinded study of continuous ropivacaine infusion in the median sternotomy incision following cardiac surgery.
The aim of this prospective, randomized, double-blind, placebo controlled trial was to evaluate the safety and efficacy of continuous ropivacaine infusion of into the sternal wound. ⋯ The phase III trial did not show improvement in time to extubation of the trachea or pain control in the 0.3% ropivacaine group, but it was stopped early by the data safety monitoring board.
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Reg Anesth Pain Med · Mar 2013
Randomized Controlled Trial Comparative StudyPharmacokinetics of sublingual sufentanil tablets and efficacy and safety in the management of postoperative pain.
A sublingual sufentanil tablet is being developed as a potential alternative to intravenous (IV) opioids for the management of postoperative pain. The objective of these studies was to evaluate the pharmacokinetics, efficacy, and safety of sublingual sufentanil tablets for postoperative pain management. ⋯ Sufentanil formulated as a sublingual solid dosage form provides a duration of action that allows effective analgesia for postoperative patients in a medically supervised setting.
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Reg Anesth Pain Med · Mar 2013
Randomized Controlled TrialContinuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty.
Local infiltration analgesia (LIA) reduces pain after total knee arthroplasty without the motor blockade associated with epidural analgesia or femoral nerve block. However, the duration and efficacy of LIA are not sufficient. A saphenous nerve block, in addition to single-dose LIA, may improve analgesia without interfering with early mobilization. ⋯ The combination of a saphenous nerve block with single-dose LIA offered better pain relief on the day of surgery than LIA alone.