Regional anesthesia and pain medicine
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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 · Jan 2012
Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement.
Use of nonsteroidal anti-inflammatory drug (NSAIDs) analgesics is controversial because of cardiovascular risk, but perioperative use may be advantageous for total joint replacement. Thus, we performed this single-center observational cohort study to determine any association between NSAID use and postoperative myocardial infarction (POMI). ⋯ Brief perioperative use of NSAIDs was not associated with increased risk for myocardial infarction after total hip and knee replacement; it may provide benefit in length of stay.
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Reg Anesth Pain Med · Jan 2012
ED50 of hyperbaric bupivacaine with fentanyl for cesarean delivery under combined spinal epidural in normotensive and preeclamptic patients.
The use of reduced intrathecal doses is advised for spinal anesthesia during cesarean delivery. However, there are inadequate data regarding the minimum effective dose of intrathecal bupivacaine for cesarean delivery. Preeclampsia is caused by an endothelial dysfunction leading to generalized vasoconstriction. Whether this can offset the pregnancy-induced decrease in intrathecal dose requirement caused by epidural venous dilation and consequent thecal compression is not known. There are no data to evaluate the minimum effective dose of intrathecal drug for cesarean delivery in preeclamptic patients. This study aimed to determine the minimum effective dose represented by the ED50 of intrathecal hyperbaric bupivacaine for normotensive and severely preeclamptic patients undergoing elective cesarean delivery. ⋯ When a combined-spinal epidural is planned in normotensive or severely preeclamptic patients for an elective cesarean delivery, the ED50 of intrathecal hyperbaric bupivacaine along with 20 μg of fentanyl is 4.7 mg.