Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialSelective ulnar nerve localization is not essential for axillary brachial plexus block using a multiple nerve stimulation technique.
The multiple-injection technique for axillary block, in which the 4 distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to produce a rapid onset and a high success rate. However, this technique may be more difficult and time consuming than other axillary block methods. A simplified multiple-nerve stimulation technique, in which the ulnar nerve was not located, was compared in the present double-blind study to the 4-injection approach. ⋯ A triple-injection method of axillary block in which the ulnar nerve was not purposely located provides a spread and a latency of sensory block equal to that obtained with a 4-injection technique. A shorter performance time is an advantage of this approach.
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Reg Anesth Pain Med · Jan 2001
Randomized Controlled Trial Clinical TrialSpinal anesthesia with hypobaric bupivacaine for knee arthroscopies: effect of posture on motor block.
The clinical impact of patient positioning on motor block during unilateral spinal anesthesia was the focus of our study. It was assumed that a 45 degrees rotation toward the prone position would minimize blocking the ventral motor roots compared with using the conventional lateral decubitus position. ⋯ The position of the patient affects the spread of the spinal anesthesia when clearly hypobaric agents are used. However, this small modification in positioning of the patient did not lead to a clinically meaningful difference in the spread of the motor block.
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Reg Anesth Pain Med · Jan 2001
Randomized Controlled Trial Clinical TrialUltrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialComparison of three catheter sets for continuous spinal anesthesia in patients undergoing total hip or knee arthroplasty.
Continuous spinal anesthesia (CSA) with microcatheters may be complicated because of technical problems. In elderly patients, some of the problems may be solved by using thicker catheters. A recent invention, involving a catheter-over-needle system, may prevent leakage of cerebrospinal fluid (CSF) and may also improve the prediction of the intrathecal position of the catheter tip. ⋯ Placement of the SC catheters was unsuccessful to a high degree, and bone contact produced distortion of the tip of some of these catheters. Otherwise, the quality associated with catheterization time, anesthetic distribution, and catheter function was similar with the 3 catheters.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffects of epidural injection on spinal block during combined spinal and epidural anesthesia for cesarean delivery.
Epidural injection has been known to enhance spinal anesthesia in combined spinal and epidural (CSE) anesthesia. Saline and local anesthetics have been reported to have a volume effect, elevating sensory level when supplementing a volume into the epidural space. We evaluated the effects of epidural injection when using the CSE technique for cesarean delivery. ⋯ We could not achieve satisfactory surgical analgesia with 8 mg of hyperbaric bupivacaine injected into the subarachnoid space using the needle-through-needle technique in cesarean deliveries. An epidural saline injection elevated the sensory level, which did not improve the spinal block, whereas an epidural injection of 10 mL of 0.25% bupivacaine enhanced the spinal block and sustained the block postoperatively.