Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialEffect of preemptive multimodal analgesia for arthroscopic knee ligament repair.
Administration of analgesic medication before surgery, rather than at the completion of the procedure, may reduce postoperative pain. Similarly, administration of multiple analgesics, with different mechanisms of action, may provide improved postoperative pain control and functional recovery. The purpose of our study was to compare pain scores and intravenous opioid consumption after outpatient anterior cruciate ligament (ACL) reconstruction in patients who received a multimodal drug combination (intravenous [IV] ketorolac, intra-articular morphine/ropivacaine/epinephrine, and femoral nerve block with ropivacaine) either before surgery or immediately at the completion of the surgical procedure. ⋯ Preemptive, multimodal administration of our 3-component analgesic drug combination resulted in lower pain scores during the initial stay in the PACU unit and lower consumption of IV PCA morphine in the PACU. However, pain scores were similar in both groups on postoperative days 1, 3, and 7; thus, there was no measurable long-term advantage associated with preemptive multimodal drug administration.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialProspective experience with a 20-gauge Tuohy needle for lumbar epidural steroid injections: Is confirmation with fluoroscopy necessary?
Small (20-gauge) Tuohy needles have been introduced for epidural steroid injection to optimize patient comfort and decrease the risk of spinal headache. These needles may be less reliable for indentification of the epidural space than standard 17- or 18-gauge needles because of their small size. We prospectively examined the success rate of lumbar epidural steroid placement with loss-of-resistance (LOR) technique compared with fluoroscopy confirmation. ⋯ In contrast to the reported 99% success rates for epidural placement of standard 17- or 18-gauge Tuohy needles, we observed a success rate of 92%. Small-gauge Tuohy needles are technically more difficult to use than larger needles and may require confirmation with fluoroscopy for correct epidural placement, especially in elderly male patients.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialHypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion.
[corrected] For decades, hypotensive anesthesia has been used in an attempt to reduce intraoperative blood loss. Hypotensive epidural anesthesia (HEA) is a relatively new technique in hypotensive anesthesia. Use of a tourniquet has been shown to be associated with a higher risk of cardiovascular and thromboembolic complications. The effect of HEA on blood loss and need for transfusion in total knee replacement (TKR) is not known. ⋯ We conclude that HEA is a safe technique that allows TKR without a tourniquet. Compared with spinal anesthesia, the use of HEA for TKR significantly reduces blood loss and the need for blood transfusion.
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Reg Anesth Pain Med · Jan 2001
Randomized Controlled Trial Clinical TrialIntrathecal low-dose bupivacaine versus lidocaine for in vitro fertilization procedures.
Recent controversy with the use of intrathecal lidocaine has prompted the search for suitable ambulatory surgery alternatives. The purpose of our study was to evaluate the clinical utility of intrathecal low-dose bupivacaine for outpatient transvaginal oocyte retrieval. ⋯ Although prolongation to voiding and discharge was observed, intrathecal hyperbaric bupivacaine 3.75 mg with fentanyl 25 microg is a viable anesthetic for oocyte retrieval.
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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.