Journal of anesthesia
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Journal of anesthesia · Aug 2014
Where is the apex of the sacral hiatus for caudal epidural block in the pediatric population? A radio-anatomic study.
Caudal epidural block (CEB), administered through the sacral hiatus, is a regional anesthetic technique commonly used in children. To facilitate and optimize pediatric CEB, morphometric data that may be important for the sacral hiatus have been obtained using multidetector computed tomography (MDCT). ⋯ Dural puncture is inevitable for CEB applied at the S2 level. Consequently, CEB should be applied below this level (range, 1.36-2.17 cm) from the midpoint of the interspinous distance between the PSIS (at the same level with S2) in children aged 1-9 years.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialMethadone patient-controlled analgesia for postoperative pain: a randomized, controlled, double-blind study.
Postoperative pain is an important health-care issue. Patient-controlled analgesia (PCA) is considered the gold standard for systemic postoperative pain treatment. Methadone PCA is used for patients with chronic pain and those in the palliative care setting. However, its efficacy as a first-line drug for acute postoperative pain is unknown. This study evaluated the use of postoperative methadone PCA after total hip arthroplasty (THA) compared with morphine PCA. ⋯ This study demonstrated that methadone PCA prompted less opioid consumption and lower pain scores at rest and at motion in comparison with morphine PCA as postoperative analgesia after THA.
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Journal of anesthesia · Aug 2014
The role of electrical stimulation in ultrasound-guided subgluteal sciatic nerve block: a retrospective study on how response pattern and minimal evoked current affect the resultant blockade.
Nerve stimulation may be combined with ultrasound imaging for a block of deeply located nerves such as the sciatic nerve in the subgluteal region. At present, it is unknown how the use of nerve stimulation affects blockade after this nerve block. We retrospectively compared the effects of the two types of motor response and those of minimal evoked current above and below 0.5 mA on ultrasound-guided subgluteal sciatic nerve block using mepivacaine or ropivacaine, two local anesthetics with different onset time and duration. ⋯ When ultrasound-guided subgluteal sciatic nerve block was conducted with nerve stimulation, the motor response pattern did not markedly affect the progress of sensory or motor blockade or block duration. Lower minimal evoked current was associated with faster onset in sensory and motor block and longer block duration after mepivacaine and faster onset in motor block after ropivacaine. The clinical significance of this, however, has yet to be determined.