Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
Pulsed radiofrequency for the treatment of occipital neuralgia: a prospective study with 6 months of follow-up.
Occipital neuralgia is a paroxysmal nonthrobbing, stabbing pain in the area of the greater or lesser occipital nerve caused by irritation of these nerves. Although several therapies have been reported, no criterion standard has emerged. This study reports on the results of a prospective trial with 6 months of follow-up in which pulsed radiofrequency treatment of the greater and/or lesser occipital nerve was used to treat this neuralgia. ⋯ Pulsed radiofrequency treatment of the greater and/or lesser occipital nerve is a promising treatment of occipital neuralgia. This study warrants further placebo-controlled trials.
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Reg Anesth Pain Med · Mar 2010
ReviewEvidence basis for ultrasound-guided block characteristics: onset, quality, and duration.
This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound (US) guidance versus other techniques for nerve localization. ⋯ There is level 1b evidence to make a grade A recommendation that US guidance provides a modest improvement in block onset and quality of peripheral nerve blocks. Ultrasound is rarely inferior to other techniques.
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Reg Anesth Pain Med · Mar 2010
ReviewThe effect of stimulating versus nonstimulating catheter techniques for continuous regional anesthesia: a semiquantitative systematic review.
Stimulating catheters provide feedback regarding the location of the catheter tip in relation to the target nerve or plexus. There is debate concerning whether stimulating catheters may reduce the failure rate of postoperative analgesia or whether they may enhance functional recovery by providing superior and more reliable postoperative analgesia. ⋯ Published reports of randomized controlled trials provide evidence for a better analgesic effect from stimulating catheters. Future trials should be conducted in a standardized manner with uniform reporting of outcomes, which may facilitate future quantitative analysis.
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Reg Anesth Pain Med · Mar 2010
ReviewModels and mechanisms of local anesthetic cardiac toxicity: a review.
Cardiovascular collapse, even death, may occur after intoxication with bupivacaine or related amide local anesthetic agents. The problem has been studied in myriad laboratories for more than 20 years. Nevertheless, there is consensus neither regarding which animal model best mimics this clinical catastrophe nor as to which ion channel, enzyme, or other local anesthetic binding site represents the point of initiation for the process. This review aimed to define the various credible mechanisms that have been proposed to explain cardiovascular collapse and death after administration of local anesthetics, particularly after bupivacaine and related agents.
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Reg Anesth Pain Med · Mar 2010
Spinal Anesthesia and Intrathecal Clonidine Decrease the Hypnotic Requirement of Propofol.
Spinal anesthesia and intrathecal clonidine are known to have hypnotic effects. We investigated the effect of spinal anesthesia and intrathecal clonidine on the requirement of propofol for sedation. ⋯ Spinal anesthesia and intrathecal clonidine might reduce the requirement of propofol for sedation. Our study showed target concentrations of propofol for sedation of 1.4 to 1.7 using local anesthesia only, 1.1 to 1.4 using spinal anesthesia with bupivacaine, and 0.7 to 0.9 microg/mL using spinal anesthesia with bupivacaine and 75 microg of clonidine