Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2012
Editorial CommentConnective tissues associated with peripheral nerves.
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Reg Anesth Pain Med · Jul 2012
Meta AnalysisDose-ranging effects of intrathecal epinephrine on anesthesia/analgesia: a meta-analysis and metaregression of randomized controlled trials.
Intrathecal epinephrine has been examined by clinical studies, but its effects on analgesia/anesthesia outcomes as well as on undesirable adverse effects is not clearly defined. The objective of this study was to examine the effects of intrathecal epinephrine on intrathecal anesthesia/analgesia. ⋯ Intrathecal epinephrine has dose-dependent clinical and adverse effects. Doses of 100 µg or less prolonged sensory and motor block duration but were associated with greater incidence of hypotension or PONV. Intrathecal epinephrine doses greater than 100 µg prolonged sensory and motor block and were not associated with greater incidence of hypotension and PONV.
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Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. In light of this evolving utility of nerve stimulation, this is an appropriate time to review the basic concepts and knowledge base of this historically important tool. ⋯ However, current magnitude is neither 100% sensitive nor specific. Independent of technical ability, both the biological environment and the equipment used impact the current-distance relationship. Thus, successful electrical nerve stimulation is dependent on an anesthesiologist with a solid foundation in anatomy and a thorough understanding of electrophysiology.
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Reg Anesth Pain Med · Jul 2012
Case ReportsEvolving compartment syndrome not masked by a continuous peripheral nerve block: evidence-based case management.
Compartment syndrome is a potentially devastating complication of many orthopedic surgeries. Whether regional anesthesia can delay the diagnosis of compartment syndrome remains a subject of debate. ⋯ Diagnosis depends on close postoperative monitoring of analgesic use and pain trends, and patients with ambulatory catheters require thorough education about compartment syndrome so they can be evaluated in a timely manner. The current literature on compartment syndrome diagnosis and regional anesthesia is limited to case reports and expert opinion, making evidence-based recommendations difficult.