Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2004
ReviewMaximum recommended doses of local anesthetics: a multifactorial concept.
The current recommendations regarding maximum doses of local anesthetics presented in textbooks, or by the responsible pharmaceutical companies, are not evidence based (ie, determined by randomized and controlled studies). Rather, decisions on recommending certain maximum local anesthetic doses have been made in part by extrapolations from animal experiments, clinical experiences from the use of various doses and measurement of blood concentrations, case reports of local anesthetic toxicity, and pharmacokinetic results. The common occurrence of central nervous system toxicity symptoms when large lidocaine doses were used in infiltration anesthesia led to the recommendation of just 200 mg as the maximum dose, which has remained unchanged for more than 50 years. ⋯ As a rule, conditions (eg, end-stage pregnancy, high age in epidural, or spinal block) or diseases (uremia) that may increase the rate of the initial uptake of the local anesthetic are indications to reduce the dose in comparison to one normally used for young, healthy, and nonpregnant adults. On the other hand, the reduced clearance of local anesthetics associated with renal, hepatic, and cardiac diseases is the most important reason to reduce the dose for repeated or continuous administration. The magnitude of the reduction should be related to the expected influence of the pharmacodynamic or pharmacokinetic change.
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Reg Anesth Pain Med · Nov 2004
Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients.
Because of the uncertainty and limitations in available randomized controlled trials, we performed an analysis of the Medicare claims database to determine whether an association exists between postoperative epidural analgesia and mortality. ⋯ Postoperative epidural analgesia may contribute to lower odds of death after surgery.
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Reg Anesth Pain Med · Nov 2004
Effect of cerebrospinal fluid return on success rate of percutaneous retrogasserian glycerol rhizotomy.
Trigeminal neuralgia is a painful syndrome, which has been commonly treated with percutaneous retrogasserian glycerol rhizotomy (PRGR). This study was performed to evaluate the effect of cerebrospinal fluid (CSF) return on the success rate of PRGR. ⋯ The presence of CSF is an important factor in determining the success rate and duration of pain relief of PRGR.
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Reg Anesth Pain Med · Nov 2004
Biography Historical ArticleDr. George Crile--early contributions to the theoretic basis for twenty-first century pain medicine.