Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2012
Lumbar dural sac dimensions determined by ultrasound helps predict sensory block extent during combined spinal-epidural analgesia for labor.
The lumbosacral cerebrospinal fluid volume is a major determinant of the intrathecal spread of local anesthetics. Ultrasound imaging of the lumbar spine allows measurement of dural sac dimensions, which may potentially be used as a surrogate of cerebrospinal fluid volume. The purpose of this study was to investigate the correlation between lumbar dural sac diameter, dural sac length (DSL), and dural sac volume (DSV), measured by ultrasound, and the intrathecal spread of isobaric bupivacaine during combined spinal-epidural (CSE) analgesia for labor. ⋯ The length of the lumbar spine determined by ultrasound, rather than the lumbar spine volume, combined with the weight or body mass index of the subject, is of particular value in predicting the intrathecal spread of isobaric bupivacaine during CSE analgesia for labor.
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Reg Anesth Pain Med · May 2012
ReviewPulsed radiofrequency in the treatment of persistent pain after inguinal herniotomy: a systematic review.
In the United States, it is estimated that between 6000 and 18,000 individuals each year present with disabling pain after inguinal hernia repair. Although surgical treatment with mesh removal is one of few options available, effective alternatives to nonsurgical management are needed. The use of pulsed radiofrequency (PFR), leading to nondestructive lesions of nerve structures, has been proposed as a treatment option. ⋯ Pain relief varied between 63% and 100%, the follow-up period was 3 to 9 months, and no adverse effects or complications were reported. In conclusion, the evidence base of PRF in persistent pain after inguinal herniotomy is fairly limited. Suggestions for improved research strategies are presented.
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Reg Anesth Pain Med · May 2012
Biography Historical ArticleCarl Koller, cocaine, and local anesthesia: some less known and forgotten facts.
Modern-day local anesthesia began in 1884 with a discovery by a young unknown ophthalmologist from Vienna named Carl Koller, who placed a cocaine solution on the cornea, thus producing insensibility. The news of his discovery spread throughout the world in less than a month. "Not surprisingly," a controversial priority discussion emerged. ⋯ In addition, Carl Koller's decision to leave Vienna is also surrounded in secrecy. The story surrounding the revelation of the local anesthetic effect of cocaine and the personalities involved is fascinating and relatively unknown.
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Reg Anesth Pain Med · May 2012
Comparative StudyThe effects of fluid injection on lesion size during bipolar radiofrequency treatment.
The effect of preinjected fluid on bipolar radiofrequency (RF) lesion characteristics has not been investigated with conventional pain medicine equipment. The purpose of the present study was to determine the effect of preinjected fluid composition on lesion parameters. ⋯ Fluid composition influences success, alters lesion size, and could be an appropriate consideration when selecting treatment parameters for bipolar RF. The enhanced lesion size and improved odds of producing a successful lesion with increasing NaCl concentration suggest a method to enlarge lesion size in a controlled manner.
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Ultrasonography of the lumbar spine provides information to facilitate the placement of neuraxial anesthesia. Likewise, thoracic spine ultrasound (US) might conceivably improve the quality and safety of thoracic epidural anesthesia. The objective of this study was to advance our understanding in this area by providing a detailed description of the sonoanatomy of the thoracic spine. ⋯ Ultrasound imaging of the thoracic spine in the PSO plane provides better views of the Lf-Dm compared with the TM plane. A upper incidence of inconclusive sonograms should be expected in the upper thoracic segments, which can be attributed to the narrower acoustic windows at these levels.