Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialThe effects of single and fractionated doses of mepivacaine on the extent of thoracic epidural block.
The effects of single and fractionated doses of local anesthetic on the extent of thoracic epidural blockade has not yet been determined. This single blinded and randomized study was designed to examine the effects of the initial dose and timing of the additional dose of local anesthetic on the sensory block level of the thoracic epidural anesthesia. ⋯ We concluded that the timing of the second administration of mepivacaine was one of the factors for the spread of the drug into thoracic epidural space. The more extensive sensory block level occurred by shorter time interval of the second drug administration.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialAnalgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery-a dose-finding study.
Interscalene brachial plexus block (ISB) with low-dose bupivacaine provides effective postoperative shoulder analgesia in outpatients. The analgesic effect of low-dose ropivacaine for ISB is unknown. ⋯ Interscalene brachial plexus block with low-dose ropivacaine, 10 mL of 0.25% and 0.5%, provides effective long-lasting shoulder analgesia in a majority of patients after arthroscopic surgery.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Comparative Study Clinical TrialEpidural analgesia compared with intravenous morphine patient-controlled analgesia: postoperative outcome measures after mastectomy with immediate TRAM flap breast reconstruction.
Epidural analgesia has been shown to provide superior pain control compared with intravenous (IV) opioids after major surgical procedures. In this study, we compared the effect of epidural analgesia and IV morphine patient-controlled analgesia (PCA) on pain relief, duration of hospitalization, oral nutrition, ambulation, and side effects in patients undergoing a major surgical procedure (i.e., unilateral mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction). ⋯ These results show that epidural analgesia compared with PCA offered improved pain control after breast reconstruction with immediate transverse rectus abdominis musculocutaneous flap reconstruction. It also resulted in a 25-hour reduction in time of hospitalization.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialClonidine premedication reduces maternal requirement for intravenous morphine after cesarean delivery without affecting newborn's outcome.
The alpha(2)-agonist clonidine has several benefits for patients undergoing surgery. During and after elective cesarean delivery (C-section), we assessed the condition of parturient and neonate when one half of the parturients were pretreated with oral clonidine. ⋯ The present results indicate that oral clonidine reduces the PCA morphine requirement after C-section without compromising the condition of the fetus or newborn. Further study including larger number of patients would be needed before we conclude that oral clonidine for parturients is safe for their newborns.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialEffect of impulse duration on patients' perception of electrical stimulation and block effectiveness during axillary block in unsedated ambulatory patients.
Chronaxie of the motor-neurons (A-alpha) is shorter than that of the sensory A-delta and C neurons. Therefore, a short current impulse should elicit a painless muscle twitch. This randomized, double-blind study of patients having ambulatory axillary block by multiple neurostimulations compared patients' perception of electrical stimulation, latency, and quality of analgesia and the incidence of adverse effects. ⋯ This study did not confirm our hypothesis that short-current impulses (0.1 ms) make neurostimulation of peripheral nerves painless, by selectively depolarizing motor-neurons. Longer impulses (0.3 ms) shorten block performance time, probably by easier location of the nerves, but the clinical relevance of this finding is doubtful.