Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialComparison of three catheter sets for continuous spinal anesthesia in patients undergoing total hip or knee arthroplasty.
Continuous spinal anesthesia (CSA) with microcatheters may be complicated because of technical problems. In elderly patients, some of the problems may be solved by using thicker catheters. A recent invention, involving a catheter-over-needle system, may prevent leakage of cerebrospinal fluid (CSF) and may also improve the prediction of the intrathecal position of the catheter tip. ⋯ Placement of the SC catheters was unsuccessful to a high degree, and bone contact produced distortion of the tip of some of these catheters. Otherwise, the quality associated with catheterization time, anesthetic distribution, and catheter function was similar with the 3 catheters.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialIntraarticular morphine and bupivacaine reduces postoperative pain after rotator cuff repair.
To determine whether intraarticular injection of morphine, fentanyl, or sufentanil added to bupivacaine provided pain control after open rotator cuff repair. ⋯ Intraarticular injection of the shoulder with 0.25% bupivacaine and 1 mg morphine at the conclusion of surgery provided pain control and diminished morphine used in the first 24 hours after open rotator cuff repair. Fentanyl and sufentanil did not improve the analgesia over that achieved with bupivacaine alone.
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Reg Anesth Pain Med · Nov 2000
Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches.
Infraclavicular brachial plexus block has been used less than other approaches because of its less uniform landmarks and the necessity of a longer needle, which increases the patient's discomfort. To overcome these drawbacks, we applied ultrasound guidance to infraclavicular approach and prospectively evaluated its feasibility and usefulness in 60 patients undergoing upper extremity surgery. ⋯ Real-time ultrasound guidance facilitates accurate infraclavicular approach to the brachial plexus. It could be used as an alternative to the landmark-guided techniques.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialA low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia.
Unilateral spinal anesthesia may be advantageous, especially in the outpatient setting. A low dose of anesthetic solution, pencil-point needle, low speed of intrathecal injection, and a lateral position have been reported to facilitate the production of unilateral distribution of spinal anesthesia. We compared the effects of plain and hyperbaric bupivacaine in attempting to obtain a unilateral spinal anesthesia for patients undergoing outpatient knee arthroscopy. ⋯ In conclusion, the spinal anesthesia in both groups are suitable alternatives for adult outpatient knee arthroscopies, but hyperbaric bupivacaine provides us with a more unilateral spinal block.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialQuality of analgesia when air versus saline is used for identification of the epidural space in the parturient.
Identification of the epidural space is often performed using the loss-of-resistance technique (LOR), commonly with air or saline. The effect of air or saline on the quality of labor epidural analgesia has not been adequately studied. ⋯ Using 0.9% saline for the LOR technique is associated with better analgesia as compared with air for labor analgesia, and this advantage should be considered when selecting the syringe contents for the LOR technique.