Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialRandomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade.
Ultrasound guidance reduces the required local anesthetic volume for successful peripheral nerve block, but it is unclear whether this influences block duration. We investigated the ropivacaine volume and concentration effect on interscalene block duration. ⋯ Block duration is influenced by both local anesthetic volume and concentration, a finding of increasing relevance with the current trend to lower volumes for ultrasound-guided regional anesthesia.
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Reg Anesth Pain Med · Sep 2012
Reliability of static and dynamic quantitative sensory testing in patients with painful chronic pancreatitis.
Quantitative sensory testing (QST) has proven to be an important instrument to characterize mechanisms underlying somatic and neuropathic pain disorders. However, its reliability has not previously been established in patients with visceral pain. We investigated the test-retest reliability of static and dynamic QST in patients with visceral pain due to chronic pancreatitis. ⋯ Sensory thresholds in the pancreatic viscerotomes and control areas were reproducible over time. In contrast, dynamic QST measurements reflecting active central modulation of pain processing state (ie, conditioned pain modulation) were not stable over time and showed considerable variability. These factors should be taken into consideration in case QST is used to follow disease mechanisms, drug effects, or effects of pain intervention.
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Reg Anesth Pain Med · Sep 2012
The sensory territory of the lateral cutaneous nerve of the thigh as determined by anatomic dissections and ultrasound-guided blocks.
A femoral block sometimes fails to provide complete sensory anesthesia of the anterior aspect of middle and distal thigh, and a block of the lateral cutaneous nerve of the thigh (LCN) is often necessary to supplement it. The goal of this study was to demonstrate, both in the anatomy laboratory and in the clinical setting, a possible contribution of the LCN to the innervation of the anterior thigh. ⋯ Our results, coming from a small sample, seem to indicate that the LCN may contribute to the innervation of the anterior thigh in some cases. A block of the LCN could be considered when a femoral block has failed to produce the expected area of anesthesia.
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Reg Anesth Pain Med · Sep 2012
Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry.
There are varying reports on the incidence of major morbidity associated with peripheral regional anesthesia. Our objective was to contribute to the knowledge regarding the incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms in the setting of ultrasound-guided peripheral regional anesthesia. ⋯ In the setting of a surgical procedure, ultrasound-guided regional anesthesia is associated with the risk of long-term postoperative neurologic symptoms. Local anesthetic systemic toxicity, however, is extremely uncommon.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialEffect of transversus abdominis plane block with and without clonidine on post-cesarean delivery wound hyperalgesia and pain.
The transversus abdominis plane (TAP) block is an established technique to manage post-cesarean delivery pain. Transversus abdominis plane blocks with a local anesthetic only offer no analgesic benefits compared with intrathecal morphine. Adjuvants to extend TAP block duration and possibly reduce wound hyperalgesia, known to be a risk factor for chronic pain, have not been studied. We hypothesized that a TAP block with clonidine will affect postsurgical wound hyperalgesia and improve pain outcomes. ⋯ Adding clonidine to a TAP block with bupivacaine did not affect wound hyperalgesia index and it did not improve short-term or long-term pain scores in women undergoing elective cesarean delivery. Further studies are warranted to determine the benefits of antihyperalgesic adjuvants in TAP solutions for specific individuals at risk for chronic pain.