Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2002
Randomized Controlled Trial Clinical TrialMultimodal analgesia and intravenous nutrition preserves total body protein following major upper gastrointestinal surgery.
This study examined whether perioperative multimodal analgesia (MMA) improves the effectiveness of intravenous nutrition (IVN) as a means of preventing protein wasting following major upper abdominal surgery (UAS). The MMA regimen utilized combined epidural opioid/local anesthetic and the systemic nonsteroidal anti-inflammatory drug (NSAID) ketorolac for 48 hours. ⋯ In conclusion, we have shown that the combination of MMA and IVN prevents protein loss and improves pain control after major UAS. Our results suggest that after UAS, MMA significantly reduced pain and, in combination with IVN, preserves total body protein and fat. This is the first direct evidence of such effects associated with a commonly used multimodal regimen.
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Reg Anesth Pain Med · Jan 2002
Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects.
The infraclavicular approach to the brachial plexus is little used despite theoretical advantages of the technique. Using a vertical paracoracoid approach, we assessed the extent of the sensory block and the incidence of adverse effects. ⋯ Single injection infraclavicular block, using a vertical paracoracoid approach, appears suitable for surgery distal to the elbow. Selective anesthesia of the medial cutaneous nerve is useful in improving tolerance of the tourniquet.
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Reg Anesth Pain Med · Jan 2002
Case ReportsLow-dose intravenous lidocaine as treatment for proctalgia fugax.
Proctalgia fugax is characterized by a sudden internal anal sphincter and anorectic ring attack of pain of a short duration. ⋯ Based on the experience reported in this case and the potential benefit of this treatment for proctalgia fugax, controlled studies comparing intravenous lidocaine with placebo should be conducted to confirm the observation and to provide a more concrete basis for the use of intravenous lidocaine for this indication.
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Reg Anesth Pain Med · Jan 2002
Case ReportsOpioid-free analgesia following total knee arthroplasty--a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac.
Traditionally, postoperative analgesia following total knee arthroplasty (TKA) has been provided by neuraxial or peripheral regional techniques with supplemental administration of opioids. We report an alternative method of postoperative pain management for patients undergoing TKA in whom the use of systemic or neuraxial opioids may result in significant side effects. ⋯ A multimodal approach consisting of continuous lumbar plexus (psoas) block and nonopioid analgesics successfully provided postoperative pain relief in our patient and facilitated her physical rehabilitation after total knee arthroplasty.