Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialLateral parasagittal versus midline interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain: a double-blind, randomized study.
Epidural steroid injections are commonly used for management of low back pain with lumbosacral radicular pain and can be administered by either interlaminar or transforaminal routes. The transforaminal route is reported to be more effective than the interlaminar route due to higher delivery of drug at the ventral epidural space. However, the transforaminal route has been associated with serious complications including spinal cord injury and permanent paralysis. Hence, there is a search for a technically better route with fewer complications for drug delivery into the ventral epidural space. Recently, a parasagittal interlaminar (PIL) approach of epidural contrast injection was reported to have 100% ventral epidural spread. However, the therapeutic efficacy of this route has never been investigated. We compared the therapeutic efficacy of the PIL approach and midline interlaminar (MIL) approach. We hypothesized that the PIL approach may produce a better clinical outcome because of better ventral epidural spread of the drug compared with MIL approach. ⋯ Epidural steroid injection administered with the PIL approach was significantly more effective for pain relief and improvement in disability than the MIL approach for 6 months in the management of low back pain with lumbosacral radicular pain.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialHypobaric spinal anesthesia with ropivacaine plus sufentanil for traumatic femoral neck surgery in the elderly: a dose-response study.
In this randomized, prospective trial, we sought to determine the effective dose of hypobaric ropivacaine with sufentanil providing 95% success (ED95) in spinal anesthesia for traumatic femoral neck surgery in the elderly. ⋯ The effective dose of hypobaric ropivacaine combined with sufentanil 5 µg providing 95% success in spinal anesthesia for traumatic femoral neck surgery in the elderly is ED95 = 9 mg (95% confidence interval, 8-14). Using doses exceeding the ED95 may increase the incidence of hypotension. If doses less than the ED95 are chosen, the use of additional analgesia may be necessary.
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Anesthesia and analgesia · Jul 2013
ReviewReview article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes.
Modern ultrasound (US) is an attractive alternative to anatomical landmark-, nerve stimulation-, and fluoroscopic-guided techniques for interventional procedures performed to treat chronic pain syndromes. ⋯ There are presently insufficient data to support improved efficacy with procedures performed with US guidance for relieving both short- and long-term chronic pain.
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Anesthesia and analgesia · Jul 2013
The effect of full expiration on the position and size of the subclavian vein in spontaneously breathing adults.
If full expiration during subclavian venous cannulation increases the distance between the subclavian vein (SCV) and the pleura or increases the diameter of the vein, it might decrease the incidence of pneumothorax and/or increase the success rate of venous cannulation. In this study, we evaluated the effect of full expiration on the distance from the SCV to the pleura and on the crosssectional area (CSA) of the SCV in spontaneously breathing adults. ⋯ The distance from the SCV to the pleura did not change after full expiration. However, this simple technique can still be considered during placement of subclavian catheters in spontaneously breathing patients, because it significantly enlarges the CSA of the SCV.