Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial
[Optimal dose of fentanyl for postoperative epidural analgesia after thoracic surgery].
We investigated the dose of fentanyl in ropivacaine for epidural anesthesia that will provide effective analgesia with minimal side effects after thoracic surgery. ⋯ We conclude that continuous epidural administration of more than 15 microg x hr(-1) of fentanyl in ropivacaine provides pain relief and few side effects after thoracic surgery.
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Ultrasound-guided techniques for peripheral nerve blocks are gaining popularity in the community of anesthesiology. This technique has many clinical benefits for regional anesthesia in the field of clinical anesthesia. These are; 1. short time for procedures; 2. peripheral nerves, blocking needles and surrounding structures around the nerves are easily recognized, and; 3. the decreased incidence of complications with insertion of the needles. The knowledge, basic considerations and some techniques of ultrasound-guided peripheral nerve blocks are described in the following articles.
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Theoretically, sciatic nerve block can be used alone or in combination with lumbar plexus block or femoral nerve block for anesthesia and/or analgesia of lower limb surgery. However, clinical use of sciatic nerve block was limited by technical difficulties in performing the block since techniques used relies only on surface anatomical landmarks. ⋯ In this article we describe the anatomy of the sciatic nerve, sonographic features, and technique of three major approaches including subgluteal, anterior, and popliteal approaches. The use of this technique for postoperative analgesia is also discussed.
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Epidural block is performed with surface landmark guidance and loss of resistance technique. Ultrasound visualization of the spinal column and surrounding structures gives additional anatomical information, which could make the block easier and safer. ⋯ The dura mater is identified as an echogenic structure inside the spinal canal. Prepuncture ultrasound examination offers useful information for epidural block such as puncture point and depth as well as angle to the epidural space.
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Femoral nerve block is well suited for surgery on the anterior aspect of the thigh and knee. The primary indication of continuous femoral nerve block is pain management after major femoral or knee surgery. Ultrasound image guidance for femoral nerve block can improve block success rate and decrease complications. We describe the ultrasound scanning, needling technique, and catheter insertion technique for single-dose technique and continuous infusion technique.