Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1999
Randomized Controlled Trial Clinical TrialThe effects of arm position on central spread of local anesthetics and on quality of the block with axillary brachial plexus block.
Spread of local anesthetic solution in axillary brachial plexus block is thought to be influenced by the position of the arm and the use of compression maneuvers. We investigated how these two factors affected central local anesthetic spread and block quality. ⋯ The central spread of local anesthetics is facilitated by injection without abduction of the arm but not by the use of compression at the injection site. This, however, did not alter the quality of the block.
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Reg Anesth Pain Med · Jan 1999
Randomized Controlled Trial Clinical TrialIntravenous administration of caffeine sodium benzoate for postdural puncture headache.
In this study, we evaluated the efficacy and safety of prophylactic administration of intravenous caffeine sodium benzoate for postdural puncture headaches (PDPH) on patients administered spinal anesthesia. ⋯ Intravenous caffeine sodium benzoate administration during spinal anesthesia is a simple and safe way to minimize PDPH.
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Reg Anesth Pain Med · Jan 1999
Multicenter Study Clinical TrialThe PENCAN 25-gauge needle: a new pencil-point needle for spinal anesthesia tested in 1,193 patients.
The PENCAN 25-gauge spinal needle is a new pencil-point needle with an inner diameter of 0.32 mm resulting in a relatively high cerebrospinal fluid (CSF) flow. The PENCAN 25-gauge needle was tested for ease of identification of a successful dural puncture, the failure rate of spinal anesthesia, and the incidence of postdural puncture headache (PDPH). ⋯ A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible "click" made prompt recognition of successful dural puncture possible.
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Although there is considerable information about the mechanisms through which injury stimuli produce acute pain, recent studies indicate that there are significant long-term consequences of persistent injury. Pain is exacerbated, in part, because of a reorganization of spinal cord circuitry in the setting of persistent injury. This review describes our studies of the contribution of the primary afferent neurotransmitter, substance P (SP), to these changes. ⋯ Taken together, these studies emphasize that persistent pain should be considered a disease state of the nervous system, not merely a symptom of some other disease conditions. In the setting of persistent injury, the nervous system undergoes dramatic changes that exacerbate and prolong the pain condition. Our studies underscore the importance of preventing the long-term changes that result from persistent injury.
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Reg Anesth Pain Med · Jan 1999
Case ReportsProgressive systemic sclerosis: intrathecal pain management.
At present, there is no reliable method for long-term treatment of severe pain from progressive systemic sclerosis (PSS) associated with Raynaud's phenomena leading to ischemia and ulcerations of the extremities. Long-term continuous intrathecal (IT) buprenorphine/bupivacaine analgesia was used in such a case. ⋯ Intrathecal infusion of buprenorphine/bupivacaine provided satisfactory long-term pain relief in a patient with PSS-associated Raynaud's phenomena, skin ulcerations, and intractable ischemic pain.