Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialEffect of preemptive multimodal analgesia for arthroscopic knee ligament repair.
Administration of analgesic medication before surgery, rather than at the completion of the procedure, may reduce postoperative pain. Similarly, administration of multiple analgesics, with different mechanisms of action, may provide improved postoperative pain control and functional recovery. The purpose of our study was to compare pain scores and intravenous opioid consumption after outpatient anterior cruciate ligament (ACL) reconstruction in patients who received a multimodal drug combination (intravenous [IV] ketorolac, intra-articular morphine/ropivacaine/epinephrine, and femoral nerve block with ropivacaine) either before surgery or immediately at the completion of the surgical procedure. ⋯ Preemptive, multimodal administration of our 3-component analgesic drug combination resulted in lower pain scores during the initial stay in the PACU unit and lower consumption of IV PCA morphine in the PACU. However, pain scores were similar in both groups on postoperative days 1, 3, and 7; thus, there was no measurable long-term advantage associated with preemptive multimodal drug administration.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialProspective experience with a 20-gauge Tuohy needle for lumbar epidural steroid injections: Is confirmation with fluoroscopy necessary?
Small (20-gauge) Tuohy needles have been introduced for epidural steroid injection to optimize patient comfort and decrease the risk of spinal headache. These needles may be less reliable for indentification of the epidural space than standard 17- or 18-gauge needles because of their small size. We prospectively examined the success rate of lumbar epidural steroid placement with loss-of-resistance (LOR) technique compared with fluoroscopy confirmation. ⋯ In contrast to the reported 99% success rates for epidural placement of standard 17- or 18-gauge Tuohy needles, we observed a success rate of 92%. Small-gauge Tuohy needles are technically more difficult to use than larger needles and may require confirmation with fluoroscopy for correct epidural placement, especially in elderly male patients.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialAssessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy.
The effectiveness of local anesthetic wound infiltration for treatment of postoperative pain appears to be variable and partly dependent on the surgical procedure. Although evidence was lacking, it was common practice at our institution to infiltrate the trocar wound of patients undergoing day-case laparoscopic procedures with long acting local anesthetic agents. The aim of this study was to investigate the analgesic efficacy, and the influence of the timing, of local anesthetic infiltration into surgical wounds for day-case diagnostic gynecological laparoscopy. ⋯ Wound infiltration with local anaesthetic did not significantly reduce pain or opioid requirement after gynecological laparoscopy.
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Reg Anesth Pain Med · Mar 2001
Case ReportsCombined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain-Barre syndrome.
The anesthetic management of labor, delivery, and cesarean delivery in patients with active or resolving Guillain-Barre syndrome is not well defined. Using a combined spinal and epidural (CSE) technique in such a rare clinical situation has not been previously reported. ⋯ Careful evaluation and documentation of the patient's baseline neurological status, a thorough discussion with the patient regarding the risks and benefits of the technique for labor analgesia, and an appreciation of the limited experience with this kind of clinical situation are important.
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Reg Anesth Pain Med · Mar 2001
What is the relationship between paresthesia and nerve stimulation for axillary brachial plexus block?
To quantify the motor threshold current of a needle following elicitation of paresthesia during axillary brachial plexus block (ABPB). ⋯ A needle position causing paresthesia produced a motor response at 0.5 mA or less in 77% of cases studied. This current may, therefore, be a reasonable threshold to aim for when performing an ABPB.