Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyPsoas compartment block for acute postoperative pain management after hip surgery in pediatrics: a comparative study with caudal analgesia.
Lower-limb peripheral nerve blocks in pediatrics have gained much more popularity in the last few decades. Our purpose of this study was to compare the postoperative analgesic effects between psoas compartment block (PCB) and caudal block in small children undergoing open hip reduction/osteotomies. ⋯ Use of single-shot PCB is superior to single-shot caudal block regarding length of postoperative analgesia and cumulative dose of morphine in small children undergoing open hip reduction/osteotomies.
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Reg Anesth Pain Med · Jan 2011
Randomized Controlled Trial Comparative StudyDecreasing the local anesthetic volume from 20 to 10 mL for ultrasound-guided interscalene block at the cricoid level does not reduce the incidence of hemidiaphragmatic paresis.
This prospective, randomized, double blind study was designed to determine whether reduction in volume from 20 to 10 mL of ropivacaine 0.5% for ultrasound-guided interscalene block might decrease the incidence of diaphragmatic paresis and preserve pulmonary function. ⋯ Decreasing the volume for interscalene block from 20 to 10 mL did not reduce the incidence of hemidiaphragmatic paresis or impairment in pulmonary function, which persisted at discharge from recovery room. No significant differences in quality or duration of analgesia were observed.
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Reg Anesth Pain Med · Jan 2011
Randomized Controlled Trial Comparative StudyA randomized comparison of infraclavicular and supraclavicular continuous peripheral nerve blocks for postoperative analgesia.
Although the efficacy of single-injection supraclavicular nerve blocks is well established, no controlled study of continuous supraclavicular blocks is available, and their relative risks and benefits remain unknown. In contrast, the analgesia provided by continuous infraclavicular nerve blocks has been validated in randomized controlled trials. We therefore compared supraclavicular with infraclavicular perineural local anesthetic infusion following distal upper-extremity surgery. ⋯ A local anesthetic infusion via an infraclavicular perineural catheter provides superior analgesia compared with a supraclavicular perineural catheter.
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Reg Anesth Pain Med · Jan 2011
Randomized Controlled Trial Comparative StudyLidocaine pretreatment with tourniquet versus lidocaine-propofol admixture for attenuating propofol injection pain: a randomized controlled trial.
Findings from studies investigating optimal techniques for attenuating propofol-related injection pain are inconsistent. In previous studies, lidocaine pretreatment using a tourniquet has been reported to be superior, inferior, or equivalent to a lidocaine-propofol admixture for reducing pain. This discordance could represent either no meaningful difference in the treatments or underlying methodological differences in the previous studies. We hypothesized that tourniquet-controlled pretreatment with lidocaine would be superior to lidocaine-propofol admixture for reducing propofol injection pain. ⋯ Tourniquet-controlled pretreatment with lidocaine is statistically superior to admixing lidocaine with propofol for reducing propofol injection pain intensity, but the clinical importance of this small effect is questionable. However, pretreatment more effectively eliminates injection pain.
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Reg Anesth Pain Med · Nov 2010
Randomized Controlled Trial Comparative StudyAnesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery.
Breast cancer is the most common malignancy in women. Surgery remains the most effective treatment. Several perioperative factors, including the surgical stress response, many anesthetics and opioids, adversely affect immune function. Regional anesthesia-analgesia attenuates perioperative immunosuppression. We tested the hypothesis that patients who receive combined propofol/paravertebral anesthesia-analgesia (propofol/paravertebral) exhibited reduced levels of protumorigenic cytokines and matrix metalloproteinases (MMPs) and elevated levels of antitumorigenic cytokines compared with patients receiving sevoflurane anesthesia with opioid analgesia (sevoflurane/opioid). ⋯ Propofol/paravertebral anesthesia-analgesia for breast cancer surgery alters a minority of cytokines influential in regulating perioperative cancer immunity. Further evaluation is required to determine the significance of these observations.