Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialSpinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison.
The aim of this prospective, randomized, double-blinded study was to compare clinical efficacy and safety of ropivacaine and bupivacaine given intrathecally in combination with morphine for cesarean delivery. ⋯ Spinal anesthesia produced with 20 mg ropivacaine plus 0.1 mg morphine is as effective and safe as that provided by 15 mg bupivacaine plus 0.1 mg morphine, with an earlier recovery of sensory and motor functions after surgery.
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Reg Anesth Pain Med · May 2004
ReviewSelective nerve root blocks for low back pain and radiculopathy.
In the management of patients with low back pain and radiculopathy, selective nerve root blocks (SNRBs) are now a common procedure for both diagnostic and therapeutic purposes. This article reviews the available studies as well as the relevant anatomy, pathology, technical considerations, and complications.
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Reg Anesth Pain Med · May 2004
Comparative StudyElectrophysiologic effect of injectates on peripheral nerve stimulation.
A small volume of local anesthetic or normal saline abolishes the muscle twitch induced by a 1ow current (0.5 mA) during electrolocation. This study examines the hypothesis that the mechanism of this phenomenon is primarily the electrophysiologic effect of the injectate on the electrical current density at the needle tip. ⋯ The injection of a conducting solution (i.e., NS) rendered the current that was previously sufficient to elicit a motor response (0.5 mA) ineffective. The most likely reason for this change is that the conductive area surrounding the stimulating needle expanded after the injection and dispersion of the conducting solution (i.e., NS), thereby reducing the current density at the target nerve. This effect can be reversed by injecting a nonconducting solution (i.e., D5W) via the stimulating needle.
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Reg Anesth Pain Med · May 2004
Comparative StudyInjection pressures by anesthesiologists during simulated peripheral nerve block.
Anesthesiologists typically rely on a subjective evaluation ("syringe feel") of possible abnormal resistance to injection while performing a peripheral nerve block (PNB). A greater force required to perform the injection is believed to be associated with intraneural injection. The hypothesis of this study is that anesthesiologists vary in their perception of "normal" injection force, that the syringe feel method is inconsistent in estimating resistance, and that needle design may affect the injection force. ⋯ Anesthesiologists vary widely in their perception of appropriate force and rate of injection during PNB. The syringe-feel method of assessing injection force is inconsistent and may be further affected by variability in needle design.
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Reg Anesth Pain Med · May 2004
Percutaneous electrode guidance using the insulated needle for prelocation of peripheral nerves during axillary plexus blocks.
Short reports have noted that percutaneous prelocation is helpful in determining the anatomic course of a peripheral nerve, and, thereby, may serve as a guide for block needle insertion. We prospectively studied percutaneous electrode guidance to assist axillary brachial plexus blocks. ⋯ Percutaneous electrode guidance using the insulated needle enabled clinicians to locate the terminal branches of the plexus in the axilla and appreciate their depth. This method could, therefore, minimize patient discomfort and perhaps the risk of nerve trauma.