Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialSelective ulnar nerve localization is not essential for axillary brachial plexus block using a multiple nerve stimulation technique.
The multiple-injection technique for axillary block, in which the 4 distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to produce a rapid onset and a high success rate. However, this technique may be more difficult and time consuming than other axillary block methods. A simplified multiple-nerve stimulation technique, in which the ulnar nerve was not located, was compared in the present double-blind study to the 4-injection approach. ⋯ A triple-injection method of axillary block in which the ulnar nerve was not purposely located provides a spread and a latency of sensory block equal to that obtained with a 4-injection technique. A shorter performance time is an advantage of this approach.
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Reg Anesth Pain Med · Jan 2001
Randomized Controlled Trial Clinical TrialSpinal anesthesia with hypobaric bupivacaine for knee arthroscopies: effect of posture on motor block.
The clinical impact of patient positioning on motor block during unilateral spinal anesthesia was the focus of our study. It was assumed that a 45 degrees rotation toward the prone position would minimize blocking the ventral motor roots compared with using the conventional lateral decubitus position. ⋯ The position of the patient affects the spread of the spinal anesthesia when clearly hypobaric agents are used. However, this small modification in positioning of the patient did not lead to a clinically meaningful difference in the spread of the motor block.
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Reg Anesth Pain Med · Jan 2001
Comparative StudyAn observational study of the frequency and pattern of use of epidural steroid injection in 25,479 patients with spinal and radicular pain.
Frequency of epidural steroid injections (ESI) and characteristics of patients receiving them are unknown or poorly described. Patients believed to respond better to ESI include young or middle-aged individuals, those with recent onset or a radicular pattern of pain, and patients without previous spinal surgery. The aim of this study is to estimate the frequency of ESI, to examine the characteristics of patients who have them recommended, and to determine if clinical practice reflects published data pertaining to indications for ESI. ⋯ ESI are commonly used to treat patients with spinal and radicular pain. There is some consistency between clinical practice and published recommendations for ESI use.
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Reg Anesth Pain Med · Jan 2001
Case ReportsAxillary brachial plexus block with patient controlled analgesia for complex regional pain syndrome type I: a case report.
Brachial plexus block (BPB) has been cited as a treatment modality for complex regional pain syndrome type I (CRPS I) of the upper limb. However, there are no reports using axillary BPB with patient controlled analgesia (PCA) for the treatment of CRPS I. This report is based on the retrospective observations of the outcome and effects of axillary BPB with PCA in a patient with CRPS I. ⋯ Axillary BPB with PCA may provide patients with CRPS I of the upper limb a feasible and effective treatment. .
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Reg Anesth Pain Med · Jan 2001
Case ReportsClonidine in preterm-infant caudal anesthesia may be responsible for postoperative apnea.
Regional anesthesia without adjunctive general anesthesia or sedation has been recommended for preterm infants to decrease the risk of postoperative apnea. Single-dose caudal local anesthetic has a limited duration, which may be insufficient for long surgery. Addition of clonidine to local anesthetics has been shown to prolong the duration of surgical analgesia. However, respiratory depression related to clonidine may occur in adults. Respiratory depression has not been reported after caudal administration of clonidine in preterm infants. Here we report a case of early postoperative apnea in a waking preterm infant after caudal anesthesia performed with lidocaine, bupivacaine, and clonidine. ⋯ Our report suggests that clonidine may be responsible for postoperative apnea in a preterm neonate. Further studies are required to determine the useful safe dose of clonidine for single-injection caudal anesthesia in those infants.