Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative pain following knee arthroscopy: the effects of intra-articular ketorolac and/or morphine.
Morphine and nonsteroidal antiinflammatory drugs (NSAID) have been found to be effective in relieving postoperative pain. The goal of this study was to determine whether ketorolac alone or in combination with morphine provides superior pain relief following arthroscopy performed with local anesthesia (LA). ⋯ The combination of 3 mg morphine plus 30 mg ketorolac provided significantly better analgesia than either placebo alone or morphine alone. This result could be a synergistic effect.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine.
Tramadol and metoclopramide have a local anesthetic effect similar to lidocaine following intradermal injection. When metoclopramide was retained in the venous system for 1 minute, it was found to be as effective as lidocaine in reducing propofol injection pain. Using this metoclopramide model, the effects of tramadol in reducing pain on propofol injection was investigated. ⋯ Using -minute retention in veins, both tramadol and lidocaine significantly reduced propofol injection pain. A local anesthetic activity is postulated.
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Reg Anesth Pain Med · May 1999
Comparative Study Clinical Trial Controlled Clinical TrialPercutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase.
Percutaneous epidural neuroplasty (epidural neurolysis, lysis of epidural adhesions) is an interventional pain management technique that has emerged over approximately the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain. In addition to local anesthetic and corticosteroid, hypertonic saline (10% NaCl) and hyaluronidase are used for the technique. The objective of this study was to determine if hypertonic saline or hyaluronidase influenced treatment outcomes. ⋯ Percutaneous epidural neuroplasty, as part of an overall pain management strategy, reduces pain (sometimes for over one year) in 25% or more of subjects with radiculopathy plus low back pain refractory to conventional therapies. The use of hypertonic saline may reduce the number of patients that require additional treatments.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Clinical TrialQuantitative sensory changes in humans after intravenous regional block with mepivacaine.
In previous studies we have demonstrated that after intravenous regional block (IVRA) with dilute mepivacaine, there is a decrease in neurogenic inflammation as well as in post-ischemic hyperemia and steady-state flow, the latter for at least 60 minutes. It is unclear whether these vascular reactions reflect a uniform depression of nerve function in the treated arms. Because the various afferents convey impulses from different types of sensory receptors, we used quantitative sensory testing (QST) to define these effects of IVRA with mepivacaine. ⋯ There was no uniform depression of nerve function after IVRA. The cold receptors and/or their Adelta-fibers were selectively depressed after the block. In conjunction with earlier findings, this suggests that IVRA with mepivacaine can differentially decrease neurogenic inflammation, with little impairment of sensory function.
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Reg Anesth Pain Med · May 1999
ReviewIntrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia.
Lipophilic opioids, especially fentanyl and sufentanil, are increasingly being administered intrathecally as adjuncts to spinal anesthesia. This review analyzes the efficacy of these opioids for subarachnoid anesthesia. ⋯ The anesthesia-enhancing properties and side-effect profile of lipophilic opioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.