Anesthesiology
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Every approach to the sciatic nerve in the buttocks currently requires the identification of pelvic bone structures. The large size of the nerve and its constant trajectory suggest that a simplified approach is possible. ⋯ Because of the intimate relationship of the sciatic nerve to the bony pelvis, the position of this nerve in the buttocks is constant. Caudal to the piriformis muscle the nerve runs vertically between the ischium and the greater trochanter. The location of this narrow passage, not the buttocks' size, determines the position of the nerve. While the size of the buttocks is variable among different individuals and in the same individual at different stages of adult life, the relationship of the sciatic nerve to the pelvis is constant throughout life. Using this relationship to our advantage, a sciatic block in adults can be accomplished at 10 cm lateral to the intergluteal sulcus without a need for identification of buried structures or line tracings.
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Gabapentin has recently been used clinically as an antihyperalgesic agent to treat certain neuropathic pain states. The aim of this study is to test whether gabapentin is able to inhibit responses to peritoneal irritation-induced visceral pain and to examine the effect of gabapentin on spinal cord amino acid release. ⋯ These data demonstrate that gabapentin effectively inhibits acetic acid-induced nociception, and the antinociceptive effect of gabapentin correlates with the suppression of noxious-evoked release of excitatory amino acids in the spinal cord.
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Many studies have demonstrated that either glutamate -methyl-d-aspartate (NMDA) receptor antagonists or opioid receptor agonists provide antinociception. Spinal coadministration of an NMDA receptor antagonist and morphine has an additive action for control of various pain states in animal models. The current study examined spinal coadministration of low doses of NMDA receptor antagonist, D-(-)-2-Amino-5-phosphonovalerate (D-APV), and mu-opioid receptor agonist, morphine sulfate (MS), in reducing visceral nociception using an acute bradykinin induced pancreatitis model in rats. ⋯ Spinal administration of combined doses of NMDA receptor antagonist, D-APV, and MS reversed three behavioral responses to induction of an acute pancreatitis model. These results suggest that in the clinical management of visceral pain, such as pancreatitis, restricted usage of glutamate antagonists might be useful as adjuvant potentiation at the onset of morphine therapy.
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Editorial Comment
Organ donation after cardiac death: what role for anesthesiologists?