Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2000
Clinical Trial1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator.
Among the supraclavicular approaches to the brachial plexus, the subclavian perivascular technique is a well-established method of anesthesia of the upper extremity. Ever since Kulenkampf described his technique, eliciting a paresthesia has been almost mandatory ("no paresthesia, no anesthesia"). Lately, nerve stimulators have become more popular. However, up to the present time, clinical studies involving the nerve stimulator have failed to show success rates comparable to paresthesia techniques. ⋯ The subclavian perivascular block consistently provides an effective block for surgery on the upper extremity. At the site of injection with this technique, the plexus is reduced to its smallest components and the sheath is reduced to its smallest volume, which explains in great part the success obtained with this block. We believe that we have demonstrated a nerve stimulator technique that is both highly successful and safe; no clinical pneumothorax was found nor did any other major complications develop.
-
Reg Anesth Pain Med · Nov 1999
Randomized Controlled Trial Clinical TrialIntravenous lidocaine, amantadine, and placebo in the treatment of sciatica: a double-blind, randomized, controlled study.
Sciatica is a neuropathic pain syndrome caused by compression and/or inflammation of spinal nerve roots by herniated disc material, and its treatment is therefore usually aimed at reducing compression and inflammation. Studies have shown that both systemic local anesthetics and N-methyl-D-aspartate (NMDA) receptor antagonists may produce analgesia in a variety of neuropathic pain syndromes. The present study evaluated the analgesic efficacy of i.v. infusions of the local anesthetic lidocaine, the NMDA receptor antagonist amantadine, and a placebo in sciatica. ⋯ Intravenous lidocaine, rather than amantadine, reduces both spontaneous and evoked sciatic pain.
-
Reg Anesth Pain Med · Nov 1999
Randomized Controlled Trial Comparative Study Clinical Trial0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine.
Although ropivacaine has been extensively studied for epidural anesthesia, very few reports exist on brachial plexus block. We therefore decided to investigate the clinical features of axillary brachial plexus anesthesia with two different concentrations of ropivacaine (0.5% and 0.75%) and to compare the results with those obtained with 0.5% bupivacaine. ⋯ Ropivacaine showed advantages over bupivacaine for axillary brachial plexus block. Because no statistical differences were found between the two ropivacaine groups, we therefore conclude that 0.75% does not add benefit and that 0.5% ropivacaine should be used to perform axillary brachial plexus blocks.
-
Reg Anesth Pain Med · Nov 1999
Randomized Controlled Trial Clinical TrialThe addition of epinephrine increases intensity of sensory block during epidural anesthesia with lidocaine.
Little is known about the effect of adding epinephrine to local anesthetic solutions on the intensity of sensory block during epidural anesthesia. This study examined development of sensory block during lumbar epidural anesthesia using a cutaneous current perception threshold (CPT) quantitative sensory testing device. ⋯ These results suggest that lumbar epidural anesthesia using 10 mL 1% lidocaine with epinephrine produces a more intense block of both large and small diameter sensory nerve fibers than that with plain lidocaine. It appears, therefore, that the addition of epinephrine improves the quality of sensory block during epidural anesthesia with lidocaine.