Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2002
Use of a charged lidocaine derivative, tonicaine, for prolonged infiltration anesthesia.
We tested the hypothesis that the duration of cutaneous anesthesia elicited by the permanently charged compound N-phenylethyl lidocaine (tonicaine) would be longer than that elicited by its parent structure, lidocaine, and that it would be less affected by epinephrine (epi), after subcutaneous injection in rats, as a model for infiltration anesthesia. ⋯ Tonicaine is a substantially longer lasting local anesthetic with a delayed onset of action compared with lidocaine and may be useful in situations where long duration of infiltration block is desirable.
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Reg Anesth Pain Med · Mar 2002
Case ReportsForaminal injection of a painful sacral nerve root using an epidural catheter: case report.
Nerve root pain has been treated with steroid injections since the 1970s. We will describe a novel method for nerve root injection using a directed epidural catheter. ⋯ This is a novel approach to treatment of painful nerve roots with a catheter.
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Reg Anesth Pain Med · Mar 2002
Chronic pain with beneficial response to electroconvulsive therapy and regional cerebral blood flow changes assessed by single photon emission computed tomography.
Recent neuroimaging studies suggested that chronic neuropathic pain may be largely sustained by a complex neuronal network involving the thalamus. Although recent studies have demonstrated the efficacy of electroconvulsive therapy (ECT) in the treatment of a variety of types of chronic neuropathic pain, the effects of ECT on regional cerebral blood flow (rCBF) have not been studied. ⋯ The results from the SPECT suggest that ECT increases abnormally decreased thalamus activity in chronic neuropathic pain.
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Reg Anesth Pain Med · Mar 2002
Estimating with confidence the risk of rare adverse events, including those with observed rates of zero.
Omission of a confidence interval (CI) associated with the risk of a serious complication can lead to inaccurate interpretation of risk data. The calculation of a CI for a risk or a single proportion typically uses the familiar Gaussian (normal) approximation. ⋯ Computer programs and simple equations are available to construct CIs reasonably accurately. In the special case in which the complication has not occurred, the risk estimated with 95% confidence is no worse than 3/n, where n is the number of trials.
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Reg Anesth Pain Med · Mar 2002
Distribution of solution in the epidural space: examination by cryomicrotome section.
The routes of distribution and barriers to flow of solutions in the epidural space are incompletely determined. This study examined macroscopic details of epidural injectate spread in postmortem humans by cryomicrotome imaging. ⋯ Distribution of solution in the epidural space is nonuniform. Rather than a uniform advancing front, spread is directed among paths between structures according to pressures by which they are compressed. No structural barriers block flow through the intervertebral foramina or spinal canal other than the fascia of the posterior longitudinal ligament.