Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialEpidural blockade suppresses lipolysis during major abdominal surgery.
The purpose of the study was to investigate the effect of thoracic epidural administration of local anesthetic, i.e., epidural block on perioperative lipolysis. ⋯ Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.
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Reg Anesth Pain Med · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialParavertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy.
Inguinal herniorrhaphy (IH) is a common outpatient procedure, yet postoperative pain and anesthetic side effects remain a problem. Paravertebral somatic nerve blocks (PVB) have the potential to offer unilateral abdominal wall anesthesia and long-lasting pain relief with minimal side effects. We compared PVB with peripheral neural blocks for outpatient IH. ⋯ This study shows that PVB provides analgesia equivalent to extensive peripheral nerve block for inguinal herniorrhaphy, offering an alternative method of postoperative pain management and perhaps fewer side effects.
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Reg Anesth Pain Med · Sep 2002
Randomized Controlled Trial Clinical TrialGabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study.
Severe phantom limb pain after surgical amputation affects 50% to 67% of patients and is difficult to treat. Gabapentin is effective in several syndromes of neuropathic pain. Therefore, we evaluated its analgesic efficacy in phantom limb pain. ⋯ After 6 weeks, gabapentin monotherapy was better than placebo in relieving postamputation phantom limb pain. There were no significant differences in mood, sleep interference, or activities of daily living, but a type II error cannot be excluded for these variables.
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Reg Anesth Pain Med · Jul 2002
Randomized Controlled Trial Clinical TrialNefopam and tramadol for the prevention of shivering during neuraxial anesthesia.
In patients undergoing neuraxial anesthesia, heat loss and core-to-peripheral redistribution of body heat causes the core temperature to decrease. The shivering threshold is therefore reached soon, and more shivering is required to prevent further hypothermia. Because shivering has deleterious metabolic and cardiovascular effects, it should ideally be prevented by pharmacologic or other means. We evaluated the usefulness of intravenous (IV) nefopam and tramadol in preventing and reducing the severity of shivering in patients undergoing neuraxial anesthesia for orthopedic surgery. ⋯ As a pharmacologic means of preventing shivering in patients undergoing neuraxial anesthesia, nefopam may hold the greatest promise.
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Reg Anesth Pain Med · Jul 2002
Randomized Controlled Trial Clinical TrialEpinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia.
Intrathecal fentanyl provides effective labor analgesia for a limited time with frequent side effects. We evaluated the effects of adding epinephrine to intrathecal fentanyl with and without bupivacaine. ⋯ These results suggest that intrathecal epinephrine does not prolong the duration of fentanyl or fentanyl with bupivacaine for labor analgesia in nulliparous parturients. Additionally, intrathecal epinephrine did not decrease the incidence of side effects and therefore cannot be recommended.