Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialAddition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block.
To evaluate the analgesic and anesthetic effects of 40 mL bupivacaine 0.25%, 40 mL bupivacaine 0.25% plus fentanyl 2.5 microg/mL, and 40 mL bupivacaine 0.125% plus fentanyl 2.5 microg/mL for axillary brachial plexus block. ⋯ The addition of 100 microg/mL fentanyl to 0.25% bupivacaine almost doubles the duration of analgesia following axillary brachial plexus block when compared with 0.25% bupivacaine alone.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialEffect of systemic adenosine on pain and secondary hyperalgesia associated with the heat/capsaicin sensitization model in healthy volunteers.
Adenosine is an endogenous compound that may have analgesic effects. Results from clinical trials are not consistent, however, and there is a need for large-scale, randomized, placebo-controlled studies to clarify the role of adenosine in the treatment of pain states, including acute nociceptive pain and pain involving central sensitization. ⋯ We conclude that adenosine has no effect on acute nociceptive pain induced by heat stimulation or on secondary hyperalgesia induced by heat/capsaicin sensitization in healthy volunteers.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialIntrathecal labor analgesia with bupivacaine and sufentanil: the effect of adding 2.25 microg epinephrine.
Epinephrine, 25 microg and 200 microg, has been found to prolong the duration of intrathecal labor analgesia when added to an opioid. In our hospital we use the standard epidural mixture, prepared by the pharmacist, containing epinephrine 1:800,000; i.e., 1.25 microg/mL for both spinal and epidural labor analgesia. We wanted to evaluate whether such a low dose, depending on its effect on duration or quality of analgesia, should be maintained or deleted in future mixtures. ⋯ It was concluded that epinephrine in a dose as low as 2.25 microg significantly prolonged the duration of intrathecal analgesia of bupivacaine-sufentanil by 15 minutes. No other differences were noticed. Diluting the commercially available bupivacaine 0.5% with epinephrine 1:200,000 may avoid the need of freshly prepared epinephrine solutions.
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Reg Anesth Pain Med · Sep 2001
Randomized Controlled Trial Clinical TrialEfficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials.
The use of radiofrequency (RF) procedures in the peripheral nervous system to treat chronic spinal pain has been the subject of controversy. Publications concerned only uncontrolled studies, and irreversible nervous tissue damage was believed to be responsible for the effect, if any. In recent years, randomized, controlled studies have appeared, which have attested to an increasing use of these techniques. This is a systematic review of randomized controlled trials on RF procedures for spinal pain. ⋯ We conclude that there is moderate evidence that RF lumbar facet denervation is more effective for chronic low back pain than placebo. Limited evidence exists for efficacy of RF neurotomy in chronic cervical zygapophyseal joint pain after flexion-extension injury. There is limited evidence that RF heating of the dorsal root ganglion is more effective than placebo in chronic cervicobrachialgia. We recommend the systematic application of our additional parameter assessments for future evaluations of RF studies. These additional parameters should also be used in the preparation of future trial protocols of RF procedures for the treatment of chronic pain.