Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2004
Randomized Controlled Trial Clinical TrialA clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery.
The aim of this study was to compare the same volume and concentration of bupivacaine and ropivacaine for interscalene brachial plexus block anesthesia and postoperative analgesia in shoulder surgery. ⋯ This study shows that the same volume and concentration of bupivacaine and ropivacaine (30 mL of 0.5%) for interscalene brachial plexus block anesthesia produce similar surgical block. When prolonging the block with a patient-controlled interscalene analgesia infusion, 0.15% bupivacaine or ropivacaine provide adequate pain relief, similar side effects, and high patient satisfaction after shoulder surgery.
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Reg Anesth Pain Med · Nov 2004
Randomized Controlled Trial Clinical TrialMedian versus musculocutaneous nerve response with single-injection infraclavicular coracoid block.
Local anesthetic injection after elicitation of a distal motor response with a nerve stimulator is believed to produce a more clinically efficient infraclavicular coracoid block than after elicitation of a proximal motor response. The aim of this study was to investigate whether elicitation of a median or of a musculocutaneous-type nerve response influenced the quality of anesthesia. ⋯ Elicitation of a median nerve response improved the efficacy of infraclavicular coracoid block when compared with a musculocutaneous nerve response. Complete paralysis and complete anesthesia of the upper limb were low in both groups.
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Reg Anesth Pain Med · Nov 2004
ReviewManagement of perioperative pain in patients chronically consuming opioids.
The prevalence of licit and illicit opioid use is growing, and a greater percentage of chronically opioid-consuming patients are presenting for surgery. These patients can be expected to experience increased postoperative pain, greater postoperative opioid consumption, and prolonged use of healthcare resources for managing their pain. ⋯ We present strategies for providing adequate analgesia to these patients that include the optimal use of opioids, adjuvant medications, and regional anesthetic techniques.
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Reg Anesth Pain Med · Nov 2004
Case ReportsTraumatic syrinx after implantation of an intrathecal catheter.
This case report describes the diagnosis and subsequent management of a very unusual complication of intrathecal pump insertion, namely that of traumatic syrinx secondary to the presence of an intrathecal catheter within the substance of the spinal canal. ⋯ Insertion of an intrathecal catheter may be associated with spinal cord trauma in patients receiving general anesthesia. Serial neurologic examinations and MRI are helpful in guiding treatment.
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Reg Anesth Pain Med · Nov 2004
Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm.
This study was designed to describe regional changes in blood oxygenation level dependent signals in functional magnetic resonance images (fMRI) elicited by thermal pain in hypnotized subjects. These signals approximately identify the neural correlates of the applied stimulation to identify neuroanatomic structures involved in the putative effects of clinical hypnosis on pain perception. ⋯ Our observations indicate that clinical hypnosis may prevent nociceptive inputs from reaching the higher cortical structures responsible for pain perception. Whether the effects of hypnosis can be explained by increased activation of the left anterior cingulate cortex and the basal ganglia as part of a possible inhibitory pathway on pain perception remains speculative given the limitations of our study design.