Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2002
Randomized Controlled Trial Comparative Study Clinical TrialPreemptive analgesia: no relevant advantage of preoperative compared with postoperative intravenous administration of morphine, ketamine, and clonidine in patients undergoing transperitoneal tumor nephrectomy.
Preemptive analgesia often failed in the clinical arena because application of a single intravenously applied drug may not prevent nociceptive input and spinal pain processing sufficiently. We therefore used an intravenous (IV), multireceptor approach and tested the preemptive analgesic effect of the antinociceptive drugs morphine, ketamine, and clonidine given before or immediately after surgery. ⋯ In contrast to encouraging observations on the combination of antinociceptive drugs, the multireceptor approach tested here failed to exert a clinically relevant effect.
-
Reg Anesth Pain Med · May 2002
Randomized Controlled Trial Clinical TrialIntrathecal hyperbaric bupivacaine dose response in postpartum tubal ligation patients.
Because of its short duration, hyperbaric lidocaine has been a popular intrathecal drug to provide anesthesia for postpartum tubal ligation (PPTL). However, reports of transient symptoms associated with its use have prompted the search for alternative intrathecal local anesthetics for short procedures. Hyperbaric bupivacaine is rarely associated with transient neurologic symptoms, and we designed this study to determine the optimal dose of bupivacaine for PPTL that assures adequate sensory block and allows the patient the shortest recovery time. ⋯ Hyperbaric bupivacaine 7.5 mg injected in the lateral position provides adequate surgical anesthesia for PPTL with a minimal duration of motor block and recovery time.
-
Topically applied single or multiagent analgesics compounded by specialty pharmacies are utilized by an unknown number of pain clinicians to unknown effect. To assess the use and perceived efficacy of these agents, an e-mail survey of members of the American Society of Regional Anesthesia and Pain Medicine was performed. Response rate was low, but identified use of compounded topical agents throughout the United States. ⋯ Use of 36 different agents of varying concentrations was reported. These clinicians perceived that 43% +/- 4% of treated patients responded favorably to the topical agents with an average of 47% +/- 3% pain relief and few side effects. Despite favorable reports of benefit, most clinicians perceived use of such compounded agents in their regions to generally be "little or none."