Regional anesthesia and pain medicine
-
Eisenmenger's syndrome is characterized by right-to-left or bidirectional shunting and pulmonary hypertension. Perioperative risk is high for noncardiac surgery, and many clinicians avoid regional anesthesia because of the potential deleterious hemodynamic effects. We determined perioperative mortality based on published reports describing anesthetic management in patients with Eisenmenger's syndrome. ⋯ This review of anesthesia and surgery in patients with Eisenmenger's syndrome reveals that most deaths probably occurred as a result of the surgical procedure and disease and not anesthesia. Although perioperative and peripartum mortalities are high, many anesthetic agents and techniques have been used with success.
-
Reg Anesth Pain Med · Sep 2002
"See one, do one, teach one, have one": a novel variation on regional anesthesia training.
Is it possible to determine the number of nerve blocks needed for residents to become competent in regional anesthesia? Several studies have focused on this question, and the Residency Review Committee (RRC) for Anesthesiology has now defined a "minimum clinical experience" for some aspects of regional anesthesia training. In our experience, personally being a regional block recipient can also serve to enhance training. ⋯ The lessons learned from personally receiving a regional anesthetic are invaluable and can improve the quality of training, as well as the relationship between anesthesiologist and patient.
-
Reg Anesth Pain Med · Sep 2002
Biography Historical ArticleEdward Tuohy: the man, his needle, and its place in obstetric analgesia.
The introduction of a needle designed by Ralph Huber and Edward Tuohy made continuous epidural anesthesia for labor possible. Neither the needle nor the regional anesthetic technique evolved in a vacuum; both were the culmination of a range of ideas developed by individuals around the world.
-
Reg Anesth Pain Med · Sep 2002
Successful interscalene block with a nerve stimulator may also result after a pectoralis major motor response.
Interscalene block of the brachial plexus is a well-established anesthetic and analgesia technique for shoulder surgery. The endpoint for successful block using the nerve stimulator has been described by previous authors as a bicep motor response (twitch) and recently by a deltoid motor response. This retrospective observational case study of regular clinical practice examined the efficacy of using the pectoralis major motor response as an endpoint for a successful block. ⋯ This retrospective observational case study of regular clinical practice suggests that a pectoralis major motor response can be a satisfactory endpoint for interscalene block.
-
Reg Anesth Pain Med · Sep 2002
Cyclooxygenase-2 inhibition potentiates morphine antinociception at the spinal level in a postoperative pain model.
After peripheral inflammatory stimuli, spinal cord cyclooyxgenase-2 (COX-2) mRNA and protein levels increase, whereas COX-1 is unchanged. In animal models of inflammatory pain, intrathecal COX-2 selective inhibitors suppress hyperalgesia. However, the role of spinal COX-2 inhibition in postoperative pain is not well elucidated. This study investigates whether a water-soluble COX-2 selective inhibitor, L-745337, can modify allodynic responses in a rat model of postoperative pain. ⋯ These results suggest a spinal interaction of COX-2 inhibition with opiate analgesia may allow a reduction of postoperative pain with lower doses of opiate.