Regional anesthesia and pain medicine
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Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block. ⋯ SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialComparison of three catheter sets for continuous spinal anesthesia in patients undergoing total hip or knee arthroplasty.
Continuous spinal anesthesia (CSA) with microcatheters may be complicated because of technical problems. In elderly patients, some of the problems may be solved by using thicker catheters. A recent invention, involving a catheter-over-needle system, may prevent leakage of cerebrospinal fluid (CSF) and may also improve the prediction of the intrathecal position of the catheter tip. ⋯ Placement of the SC catheters was unsuccessful to a high degree, and bone contact produced distortion of the tip of some of these catheters. Otherwise, the quality associated with catheterization time, anesthetic distribution, and catheter function was similar with the 3 catheters.
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Reg Anesth Pain Med · Nov 2000
Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches.
Infraclavicular brachial plexus block has been used less than other approaches because of its less uniform landmarks and the necessity of a longer needle, which increases the patient's discomfort. To overcome these drawbacks, we applied ultrasound guidance to infraclavicular approach and prospectively evaluated its feasibility and usefulness in 60 patients undergoing upper extremity surgery. ⋯ Real-time ultrasound guidance facilitates accurate infraclavicular approach to the brachial plexus. It could be used as an alternative to the landmark-guided techniques.
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Reg Anesth Pain Med · Nov 2000
Case ReportsSuccessful management of pleuritic pain with thoracic paravertebral block.
Thoracic paravertebral block (TPVB) is a unilateral analgesic technique that has been advocated in both acute and chronic thoracic and abdominal pain. Other blocks such as interpleural and epidural can be effectively used in pleuritic pain. This report illustrates that TPVB could also be effective for this kind of pain. ⋯ This case report supports the notion that, in practice, the paravertebral block could be an effective and safe alternative to relief of pleuritic pain.
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Reg Anesth Pain Med · Nov 2000
Spread of injectate during C6 stellate ganglion block and fascial arrangement in the prevertebral region: an experimental study using donated cadavers.
The precise fascial space through which the injectate spreads during stellate ganglion block (SGB) remains unclear. Recent studies using magnetic resonance imaging or computed tomography have suggested that the injectate is deposited around and/or within the longus colli muscle during SGB. However, a fascial space, close to the longus colli, is the most likely route of spread. We identified the prevertebral interlaminal space (PVILS), situated between the anterior and posterior laminae of the prevertebral layer of the fascia, as an important route for the spread of the injectate and as a potential pathway to the ganglion. The danger of downward spread of deep infections through this space has previously been recognized. ⋯ These results suggest that the PVILS plays a critical role in the spread of injectate as well as being a potential pathway to the stellate ganglion during SGB.