Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Clinical TrialEfficacy of three doses of ketamine with bupivacaine for caudal analgesia in pediatric inguinal herniotomy.
Ketamine administered systemically is a potent analgesic at subanesthetic plasma concentrations. Addition of ketamine to bupivacaine for caudal epidural block significantly prolongs the duration of postoperative analgesia. The purpose of this prospective, randomized double-blind study is to identify the optimal dose of ketamine that produces the maximum duration of caudal analgesia with minimal adverse effects as an adjuvant to bupivacaine for caudal epidural block. ⋯ The optimal dose of ketamine in our study was 0.5 mg/kg added to 0.75 mL/kg bupivacaine 0.25% for caudal epidural block without an increase in side effects.
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of lateral popliteal versus lateral midfemoral sciatic nerve blockade using ropivacaine 0.5%.
The midfemoral approach to the sciatic nerve (MF) is a new technique that has been used for postoperative analgesia after knee surgery. The aim of the present study was to compare efficacy, performance time, and patient acceptance of the midfemoral approach to that of the lateral approach at the level of the popliteal fossa (popliteal block [PB]). ⋯ The midfemoral approach to the sciatic nerve for ankle and foot surgery resulted in a reliable anesthetic, comparable to that of the lateral popliteal approach. This technique is simple, safe, and provides postoperative analgesia as effective as that obtained with the lateral approach.
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Reg Anesth Pain Med · Jan 2004
Clinical TrialLower lobe collapse during continuous interscalene brachial plexus local anesthesia at home.
We report a case of pulmonary left lower lobe collapse following an interscalene local anesthetic infusion administered at home. This case highlights the need for patient education and postoperative communication. ⋯ Good communication must be maintained with the patient at all times. Doctors from other specialties may be unaware of the potential complications of an interscalene block.
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Reg Anesth Pain Med · Jan 2004
Case ReportsMisplacement of a psoas compartment catheter in the subarachnoid space.
This case report describes an unusual cause of misplacement of an indwelling catheter in the subarachnoid space after primary psoas compartment block in a patient undergoing total knee arthroplasty. ⋯ An additional test dose via the catheter is recommended if the indwelling catheter is inserted after injection of the local anesthetics through the puncture needle. If epidural anesthesia occurs, an x-ray of the catheter is advisable because negative aspiration via catheter does not rule out subarachnoid catheter location.
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Reg Anesth Pain Med · Jan 2004
Case ReportsAccidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence.
Until now, case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a delayed onset, after low doses of local anesthetic, with a characteristic radiographic appearance on contrast injection. Our radiographic investigation of atypical "epidural" blocks has revealed that subdural injection may go unrecognized clinically and may be a cause of inadequate blocks. The mechanism is explored. ⋯ Accidental subdural injection may now be added to the list of causes of failed or inadequate "epidural" block. Clinicians should be aware of the diagnosis of a possible subdural injection, if a poor quality block with restricted spread and slow onset is associated with pain on postoperative reinjection of the catheter.