Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Sep 2005
Randomized Controlled Trial Comparative StudyA comparison of proximal and distal radial nerve motor responses in axillary block using triple stimulation.
Stimulation of the radial nerve at the axilla may cause either a proximal movement (forearm extension) or distal movements (supination, wrist or finger extension). In the most recent studies on axillary block, only a distal twitch was accepted as valid. However, this approach was based only on clinical experience. The aim of this study was to verify if a proximal motor response can be considered a satisfactory endpoint. ⋯ Local anesthetic injection at the proximal radial twitch significantly reduces the efficacy and prolongs the onset time of the radial nerve block. Searching for distal response is significantly more difficult and time consuming than searching for proximal response. However, it does not significantly increase patient discomfort or adverse effects.
-
Reg Anesth Pain Med · Sep 2005
Comparative StudyNeurotoxicity of intrathecally administered bupivacaine involves the posterior roots/posterior white matter and is milder than lidocaine in rats.
Clinical and laboratory studies suggest that lidocaine is more neurotoxic than bupivacaine. However, histological evidence of their comparative neurotoxicity is sparse. We thus pathologically and functionally compared the intrathecal neurotoxicity of these agents. ⋯ The neurotoxic lesions caused by bupivacaine and lidocaine were indistinguishable in the primary site and the extending pattern, such as axonal degeneration originating from the posterior roots and extending to the posterior white matter. The intrathecal neurotoxicity is greater in lidocaine than in bupivacaine.
-
Reg Anesth Pain Med · Sep 2005
Randomized Controlled Trial Comparative StudyEffects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty.
Regional analgesic techniques allow better postoperative rehabilitation and shorter hospital stay after major knee surgery. The authors tested the hypothesis that similar results could be obtained after total-hip arthroplasty. ⋯ This study suggests that IV PCA with morphine, continuous FNB, and continuous epidural analgesia provide similar pain relief and allow comparable hip rehabilitation and duration of hospital stay after total-hip arthroplasty (THA). As continuous FNB is associated with less side effects, it appears to offer the best option of the three.
-
Reg Anesth Pain Med · Sep 2005
Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale.
Although the literature contains information about prevalence and incidence of low-back pain (LBP), little information is available about the contribution of the neuropathic element to LBP. Our study was designed to investigate the prevalence of neuropathic pain among a sample of chronic LBP patients in Saudi Arabia by use of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. ⋯ Neuropathic pain is a major contributor to chronic LBP, and the LANSS pain scale is a useful tool to distinguish patients with neuropathic pain from those with nociceptive pain.