Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2001
Confirmation of location of epidural catheters by epidural pressure waveform and computed tomography cathetergram.
Epidural pressure has remained a relatively unused test of physiological monitoring for the past 3 decades. It is our hypothesis that epidural pressure waveforms (EPWFs) obtained by transducing an epidural catheter (EC) can be used as a surrogate for the accurate location of the EC. The goal of this study was to validate this new method by comparing it with a more objective radiographic technique such as computed tomography cathetergram (CTC). ⋯ The strong relationship between EPWF and CTC suggests that EPWF can be used reliably to confirm the correct placement of the EC in a selected group of patients.
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Reg Anesth Pain Med · Jul 2001
Case ReportsRepeated psoas compartment blocks for the management of long-standing hip pain.
The psoas compartment block is used to produce analgesia of the lumbar plexus mainly for hip and knee surgery. It has also been used for the management of a long-standing pain due to hip joint degeneration. ⋯ We successfully performed repeated psoas compartment blocks with a local anesthetic and subsequently with added opioids, which produced substantial pain relief, especially after the addition of opioids.
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Reg Anesth Pain Med · Jul 2001
The injection of intrathecal normal saline reduces the severity of postdural puncture headache.
We investigated whether the injection of 10 mL of normal saline into the subarachnoid space following accidental dural puncture reduced the incidence of postdural puncture headache (PDPH) and the need for epidural blood patch (EBP). ⋯ The immediate injection of 10 mL intrathecal normal saline after a wet tap significantly reduced the incidence of PDPH and the need for EBP. When an intrathecal catheter had been placed following a wet tap, injection of 10 mL of normal saline before its removal effectively prevented PDPH.
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Reg Anesth Pain Med · Jul 2001
Editorial CommentMultimodal therapy for post-cesarean delivery pain.
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Reg Anesth Pain Med · Jul 2001
The effect of distance from injection site to the brainstem using spinal sufentanil.
Intrathecal (IT) sufentanil is commonly used in parturients to provide rapid onset of labor analgesia without motor block. This practice, although widely used, has been associated with severe respiratory depression in some patients. The mechanism of this respiratory depression is unclear, however, rapid cephalad movement and interaction with parenteral opioids are 2 frequently cited explanations for this complication. Because this complication has occurred only in women with heights between 150 and 157 cm, we elected to study the effect of the distance from injection site to the cisterna magna (CM) on peak brainstem cerebrospinal fluid (CSF) concentrations. ⋯ Our results suggest that sufentanil migrates relatively large distances in the IT space. Injection site (distance from the brainstem) appears to be a prominent factor in determining brainstem concentrations and subsequent respiratory depression after spinal administration. Reg Anesth Pain Med 2001;26:306-309.