Regional anesthesia and pain medicine
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Skeletal muscle toxicity is a rare and uncommon side effect of local anesthetic drugs. Intramuscular injections of these agents regularly result in reversible myonecrosis. The extent of muscle damage is dose dependent and worsens with serial or continuous administration. ⋯ In this respect, the quantitative impact of further mitochondria-mediated pathways--at least in bupivacaine toxicity--is still to be established. Although experimental myotoxic effects are impressively intense and reproducible, only a few case reports of myotoxic complications in patients after local anesthetic administrations have been published. In particular, the occurrence of clinically relevant myopathy and myonecrosis has been described after continuous peripheral blocks, infiltration of wound margins, trigger point injections, and peri- and retrobulbar blocks.
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Reg Anesth Pain Med · Jul 2004
Clinical TrialThe effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin.
The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 microg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. ⋯ We conclude that 1.25 microg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.
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Reg Anesth Pain Med · Jul 2004
Case ReportsCervical epidural analgesia via a thoracic approach using nerve stimulation guidance in an adult patient undergoing elbow surgery.
This case report describes the placement of a cervical epidural catheter via the thoracic approach, using nerve stimulation, in a patient undergoing elbow surgery. ⋯ This case report suggests that electrical stimulation may allow one to accurately position epidural catheters in the central neuraxial space to provide reliable, effective analgesia of the upper extremity. This approach might be an alternative way to deliver cervical epidural analgesia for patients undergoing upper extremity surgery.
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Reg Anesth Pain Med · Jul 2004
Case ReportsUltrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease.
Interest in ultrasound-guided nerve block is increasing, but clinical utility still is being determined. We report a case in which ultrasound imaging aided nerve localization during popliteal block. ⋯ Ultrasound guidance can facilitate lateral popliteal catheter insertion in patients in whom electrolocation has failed.
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Reg Anesth Pain Med · Jul 2004
Case ReportsCombined spinal-epidural technique for vaginal hysterectomy in a patient with Machado-Joseph disease.
Machado-Joseph disease is a form of progressive spino-cerebellar ataxia with both bulbar and peripheral neurological manifestations. To date, anesthesia for patients affected by this disease has not been described. General anesthesia may be problematic because of the risk of pulmonary aspiration and hypoxia. We describe our experience with the successful use of combined spinal-epidural in a patient with Machado-Joseph Disease (MJD). ⋯ Central neuraxial anesthesia is an option for patients with MJD presenting for lower abdominal and lower extremity operations. Combined spinal-epidural anesthesia confers hemodynamic stability yet allows for augmentation of intraoperative anesthesia and postoperative analgesia.