Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1998
Comparative StudyHigh thoracic epidural block relieves acute herpetic pain involving the trigeminal and cervical regions: comparison with effects of stellate ganglion block.
Stellate ganglion block can promptly relieve acute herpetic pain (AHP) involving the trigeminal and cervical regions. However, repeated blocks are needed to maintain pain relief in most patients with severe AHP. Because continuous epidural block is easily performed using an indwelling catheter, we compared the effect of high thoracic epidural block with that of stellate ganglion block to relieve moderate-to-severe AHP involving these regions. ⋯ High thoracic epidural block was as effective as stellate ganglion block in relieving moderate-to-severe AHP involving the trigeminal and cervical regions.
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Reg Anesth Pain Med · Jan 1998
Defining the cross-sectional anatomy important to interscalene brachial plexus block with magnetic resonance imaging.
Interscalene brachial plexus block is a useful technique to provide anesthesia and analgesia for the shoulder and proximal upper extremity. The initial needle direction at the interscalene groove has been described as being "perpendicular to the skin in every plane" (1). A cross-sectional (axial) approach may offer a more easily conceptualized directed needle placement. The purpose of this study is to define the cross-sectional anatomy and idealized needle angles important to interscalene brachial plexus block. ⋯ These findings suggest initial needle placement at the interscalene groove should be angled less perpendicularly relative to the sagittal plane than is often observed. A cross-sectional approach enables more practical visualization of initial needle placement. A more accurate initial needle placement may minimize the number of needle passes necessary to contact the nerve roots, thereby more efficiently obtaining a successful block.
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Reg Anesth Pain Med · Jan 1998
Epidural pressures and spread of 2% lidocaine in the epidural space: influence of volume and speed of injection of the local anesthetic solution.
The impact of epidural pressures on the spread of epidural block is controversial. This study examined the effect of volume and speed of injection of local anesthetics on epidural pressures and the spread of anesthesia. ⋯ The peak epidural pressures correlated with the speed of injection of the lidocaine solution and not with its volume, whereas the remaining epidural pressures correlated with its volume and not with the speed of injection. The extent and duration of the thermal block exhibited a more consistent correlation (inverse and direct, respectively) with the epidural pressures than those of the sensory block.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical Trial2-Chloroprocaine and bupivacaine are unreliable indicators of intravascular injection in the premedicated patient.
Epinephrine-containing test doses for detection of intravascular injection during epidural anesthesia may be unreliable or hazardous in beta-blocked, elderly, or pregnant patients. Subtoxic injections of lidocaine have been used as an alternative marker of intravascular injection in unpremedicated patients. We studied two groups of premedicated patients and unpremedicated subjects to evaluate the reliability of the local anesthetics bupivacaine (B) and 2-chloroprocaine (2-CP) as test dose injections. ⋯ While 90 mg 2-CP or 25 mg B may be reliable alternatives to epinephrine test doses in unpremedicated subjects, they are unreliable indicators of intravascular injection in the premedicated patient.