Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2002
Case ReportsPatient-controlled epidural analgesia for labor and delivery in a parturient with chronic inflammatory demyelinating polyneuropathy.
The anesthetic management of labor and delivery in patients with any form of chronic inflammatory demyelinating polyneuropathy (CIDP) is not well defined. Using patient-controlled epidural analgesia (PCEA), or epidural analgesia, in such a rare clinical situation has not been previously reported. ⋯ PCEA had no apparent detrimental affect on the patient's disease and may be a reasonable option for patients with CIDP presenting for labor and delivery.
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Reg Anesth Pain Med · Jan 2002
Case ReportsIntrathecal baclofen: a useful agent in the treatment of well-established complex regional pain syndrome.
We present 2 case reports that illustrate that chronic intrathecal (IT) baclofen administration may be efficacious in treating patients with long-standing complex regional pain syndrome, type I (CRPS I) who have failed treatment with multiple drugs and procedures. ⋯ IT baclofen appears to be an option for patients with intractable CRPS who have failed other modalities, including IT morphine.
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Reg Anesth Pain Med · Jan 2002
Randomized Controlled Trial Clinical TrialMultimodal analgesia and intravenous nutrition preserves total body protein following major upper gastrointestinal surgery.
This study examined whether perioperative multimodal analgesia (MMA) improves the effectiveness of intravenous nutrition (IVN) as a means of preventing protein wasting following major upper abdominal surgery (UAS). The MMA regimen utilized combined epidural opioid/local anesthetic and the systemic nonsteroidal anti-inflammatory drug (NSAID) ketorolac for 48 hours. ⋯ In conclusion, we have shown that the combination of MMA and IVN prevents protein loss and improves pain control after major UAS. Our results suggest that after UAS, MMA significantly reduced pain and, in combination with IVN, preserves total body protein and fat. This is the first direct evidence of such effects associated with a commonly used multimodal regimen.
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Reg Anesth Pain Med · Jan 2002
Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects.
The infraclavicular approach to the brachial plexus is little used despite theoretical advantages of the technique. Using a vertical paracoracoid approach, we assessed the extent of the sensory block and the incidence of adverse effects. ⋯ Single injection infraclavicular block, using a vertical paracoracoid approach, appears suitable for surgery distal to the elbow. Selective anesthesia of the medial cutaneous nerve is useful in improving tolerance of the tourniquet.