Regional anesthesia
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Regional anesthesia · Nov 1995
Clinical TrialArea of paresthesia as determinant of sensory block in axillary brachial plexus block.
Paresthesia is widely considered a useful indicator for locating components of the brachial plexus using the axillary approach. While establishing axillary brachial plexus blocks, the authors attempted to correlate the area of paresthesia with the effectiveness of the sensory block. ⋯ Eliciting paresthesia at the nerve supplying the area of a planned surgical incision is a reliable determinant of successful axillary brachial plexus block.
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Regional anesthesia · Nov 1995
Comparative Study Clinical Trial Controlled Clinical TrialImpact of patient-controlled analgesia on required nursing time and duration of postoperative recovery.
Patient-controlled analgesia (PCA) offers effective postoperative pain management. However, the evidence of economic benefits associated with its use is lacking. Although suggestive, the potential economic advantages of PCA in saving nursing time and shortening hospital stay need objective documentation. ⋯ Data in this study have demonstrated some beneficial effects of PCA on nursing time requirements when it was used following cholecystectomy and lumbar laminectomy at the University of Toronto: however, the magnitude of these benefits was less than previously reported. The effects of PCA on postoperative recovery and hospital stay, however, were not significantly different from i.m. therapy.
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Regional anesthesia · Nov 1995
The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients.
The present study was performed at the Crystal Clinic Surgery Center, an outpatient free-standing surgicenter specializing in orthopedic surgery, to determine the incidence of both neurologic and vascular sequelae associated with exclusive use of a transarterial approach to axillary brachial plexus block in order to assess the technique's safety and efficacy. ⋯ This study demonstrated the safety and efficacy of the transarterial technique in achieving brachial plexus block.
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Regional anesthesia · Nov 1995
Comparative StudyComparison of thrombelastography with common coagulation tests in preeclamptic and healthy parturients.
Epidural analgesia/anesthesia is often beneficial in the management and treatment of preeclampsia. However, some preeclamptic patients have a coagulopathy that is a contraindication to regional anesthesia. A routine coagulation battery (RCB) consisting of prothrombin time, partial thromboplastin time, platelet count, and bleeding time, is commonly performed to assess coagulation status. Thrombelastography (TEG) is a measure of clotting that allows evaluation of overall coagulation activity. The goal of this study was to examine whether TEG can predict normal and abnormal coagulation as diagnosed by RCB in healthy and preeclamptic parturients. ⋯ Thrombelastography is not an effective means of predicting abnormal coagulation, as diagnosed by RCB, in preeclamptic parturients, using currently defined normal TEG values for nonpregnant patients. However, an abnormal TEG maximum amplitude value always correlated with a prolonged bleeding time. Therefore, TEG may be useful in assessing platelet function in the presence of thrombocytopenia. Further studies are warranted.
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Effective management of severe pain in acute pancreatitis is one of the important issues in therapy, as pain reflexes can contribute to the development of life-threatening secondary complications. Although opioid derivatives are still clinically in use, the direct interruption of afferent nociceptive visceral stimulation (e.g., by segmental epidural block) is claimed to be much more effective method of pain relief. However, in a group of the patients with alcohol ingestion as the etiology of pancreatitis and history of drug/opioid addiction in the background, epidural block failed to alleviate the pain. Study aim was to assess the effect of continuous celiac plexus block as an alternative analgesic method in patients with acute pancreatitis by using a retrospective analysis. ⋯ Intermittent or continuous unilateral celiac plexus block offers an effective alternative treatment for pain in acute pancreatitis, especially in patients with alcohol etiology and history of drug/opioid addiction, in whom the conventional methods fail to give proper pain relief.