Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyTriple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block.
Practitioners mix faster-onset, intermediate-duration local anesthetics (LAs) with slower-onset, long-duration LAs to get fast peripheral nerve block (PNB) onset and long duration. We hypothesized that 1.5% mepivacaine (with epinephrine) (mepivacaine) or 1.5% mepivacaine (with epinephrine) mixed with 0.5% bupivacaine (mixed) would reduce PNB sensory onset by 20% or more versus 0.5% bupivacaine alone (bupivacaine). ⋯ Mixing 1.5% mepivacaine (with epinephrine) with 0.5% bupivacaine speeds up PNB sensory (motor) onset compared with 0.5% bupivacaine alone.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyComparison of a single- or double-injection technique for ultrasound-guided supraclavicular block: a prospective, randomized, blinded controlled study.
Despite good success rates reported with ultrasound-guided supraclavicular block using 1 or multiple injections, no consensus exists on the best technique to use. We designed this study to test the hypothesis that a double-injection technique would hasten the onset of sensory block. ⋯ The double-injection technique offers no benefit over a single injection for the performance of an ultrasound-guided supraclavicular block.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled TrialASRA checklist improves trainee performance during a simulated episode of local anesthetic systemic toxicity.
Severe local anesthetic systemic toxicity (LAST) is a rare event, the management of which might best be learned using high-fidelity simulation. In its 2010 Practice Advisory, the American Society of Regional Anesthesia and Pain Medicine (ASRA) created a medical checklist to aid in the management of LAST. We hypothesized that trainees provided with this checklist would manage a simulated episode of LAST more effectively than those without it. A secondary aim of the study was to assess the ASRA Checklist's usability and readability. ⋯ Use of the ASRA Checklist significantly improved the trainees' medical management and nontechnical performance during a simulated episode of severe LAST. Partial use of the checklist correlated with lower overall performance.
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Reg Anesth Pain Med · Nov 2011
Randomized Controlled Trial Multicenter Study Comparative StudyLumbar transforaminal epidural dexamethasone: a prospective, randomized, double-blind, dose-response trial.
Serious adverse events related to particulate steroids have curtailed the use of transforaminal epidural steroid injections for radicular pain. Dexamethasone has been proposed as an alternative. We investigated the efficacy, dose-response profile, and safety of 3 doses of epidural dexamethasone. ⋯ Transforaminal epidural dexamethasone provides statistically significant and clinically meaningful improvement in radicular pain at 12 weeks after injection, with parallel improvements in disability, impression of change, and satisfaction measures. There was no difference in efficacy for dexamethasone 4 mg compared with 8 or 12 mg. The optimal dose of epidural dexamethasone may be lower than 4 mg, further increasing the long-term safety and tolerability of this treatment. Current data are reassuring with regard to the safety of dexamethasone for transforaminal epidural steroid injection.
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Reg Anesth Pain Med · Nov 2011
Randomized Controlled TrialA translational study of the effects of ketamine and pregabalin on temporal summation of experimental pain.
Central sensitization is often seen in chronic pain. A relevant and potent mechanism of central sensitization is the central integration of nociceptive impulses. Temporal summation in humans and the wind-up process in animals share common features of central integration. This preclinical and clinical translational study investigated the effect of ketamine and pregabalin on temporal summation (TS) and wind-up of wide dynamic range (WDR) neurons of nociceptive electrical stimuli in healthy volunteers and rats. ⋯ It was shown that TS shares common features with wind-up of WDR neurons and that pregabalin does not affect this component of central sensitization.