Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1998
Case ReportsParaplegia following intracord injection during attempted epidural anesthesia under general anesthesia.
A case of permanent paraplegia is reported following attempted epidural anesthesia for a total knee replacement in a 62-year-old woman with a history of lumbar laminectomy for a prolapsed intervertebral disc. ⋯ Standards of management are discussed in relation to this case.
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Reg Anesth Pain Med · Jan 1998
Intrathecal addition of morphine to bupivacaine is not the cause of postoperative nausea and vomiting.
Postoperative nausea and vomiting after anesthesia is an distressing side effect. This study was undertaken to determine to what extent spinal opioids contribute to postoperative nausea and vomiting (PONV) and secondly to how effectively metoclopramide can reduce the incidence of PONV after intrathecal administration of morphine. ⋯ Administration of metoclopramide did not reduce the overall incidence of PONV. Our study shows no relationship between the use of intrathecal morphine and the incidence of PONV during the first 24 hours postoperative.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialSphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders.
This study examined the effectiveness of sphenopalatine ganglion block (SPGB) for myofascial pain syndrome of the head, neck, and shoulders using a double-blind, placebo-controlled, crossover study design with comparison to an internal standard consisting of trigger point injections (TPI). ⋯ This study suggests that SPGB with 4% lidocaine is no more efficacious than placebo and less efficacious than administration of standard trigger point injections in the treatment of myofascial pain of the head, neck, and shoulders.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of remifentanil and propofol infusions for sedation during regional anesthesia.
Patients treated with regional anesthesia often require concomitant medication for comfort and sedation. Propofol is widely used for this purpose. Remifentanil, a new ultra-short-acting opioid, exhibits at low doses distinct sedative properties that may be useful for supplementation of regional anesthesia. This study compared the effectiveness of remifentanil and propofol infusions for providing sedation during regional block placement and surgery. ⋯ When titrated to the same sedation level, remifentanil provided a smoother hemodynamic profile than propofol during regional anesthesia. The frequent occurrence of remifentanil-induced respiratory depression requires cautious administration of this agent. The incidence of adverse reactions seen with both agents during and after their administration makes the management of such sedative infusion techniques difficult.
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Reg Anesth Pain Med · Jan 1998
The effects and side effects of interscalene brachial plexus block by posterior approach.
To investigate the use of interscalene block by posterior approach in upper extremity surgery and its effects on routine pulmonary function tests. ⋯ Interscalene block by posterior approach did not provide a satisfactory anesthesia for forearm and hand surgery. This method also caused hemidiaphragmetic paresis and a reduction in pulmonary function tests as in the lateral approach of Winnie. We believe limitations and relative contraindications for interscalene block by lateral approach are the same for posterior approach.