Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2006
Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations.
Lumbar-plexus and sciatic-nerve blocks are commonly combined for lower-extremity anesthesia using large doses of ropivacaine. Limited information is available about the pharmacokinetics of this practice. We analyzed plasma ropivacaine concentrations after single-injection lumbar-plexus blocks with and without sciatic-nerve blocks. ⋯ The results of this study demonstrate that the plasma ropivacaine concentrations increase quicker when a sciatic-nerve block is added to a lumbar-plexus block, but C(max) remains below the toxicity threshold.
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Reg Anesth Pain Med · Sep 2006
Comparative StudyHealth-related quality of life in sacroiliac syndrome: a comparison to lumbosacral radiculopathy.
This study attempts to assess the intensity and quality of pain and health-related quality of life in patients with sacroiliac syndrome and to compare those constructs to patients with lumbar radiculopathy. ⋯ The results of this study suggest the following: (1) no true difference exists in the health-related quality of life or pain scores/descriptors between patients with SI syndrome or lumbar radiculopathy, or (2) the presence of comorbid spinal conditions confounds the ability of the SF-36 to detect disparities in health-related quality of life among differing etiologies of low-back pain, despite the use of rigorous diagnostic criteria, and/or (3) other factors besides the diagnostic categories of low-back pain (e.g., functional capability, psychological stress) may be primary determinants of health-related quality of life. To our knowledge, no other study has attempted to use the SF-36 to detect differences in health-related quality of life among patients with different spinal diagnoses.
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Reg Anesth Pain Med · Sep 2006
Use of sequential electrical nerve stimuli (SENS) for location of the sciatic nerve and lumbar plexus.
Conventional electrical stimulation has been done by continuous adjustment of current amplitude at a single, set pulse duration (conventionally, 0.1 ms). This study evaluated a novel technique for nerve location by utilization of a peripheral-nerve stimulator (PNS) programmed to deliver sequential electrical nerve stimuli (SENS). A repeating series of alternating sequential pulses of 0.1, 0.3, and 1.0 ms at 1/3-second period intervals between pulses were generated so that at a greater distance from the nerve, only higher-duration pulses would stimulate the targeted nerve and result in 1 or 2 motor responses (MR) per second. Three MR per second at 0.5 mA or less signified the conventional endpoint for nerve location (
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Reg Anesth Pain Med · Sep 2006
Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control.
For diagnostic lumbar medial-branch blocks, fluoroscopic guidance is considered mandatory, but this technique comes with radiation exposure. The clinical feasibility of the ultrasound-guided lumbar medial-branch block has been demonstrated. We evaluated the success rate and validity of this new method by use of fluoroscopy controls in patients previously diagnosed with lumbar facet joint-mediated pain. ⋯ Ultrasound-guided lumbar medial-branch blocks can be performed with a high success rate. However, to be completely independent from fluoroscopy controls, this technique requires further studies regarding the detection of intravascular spread.