Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialZiconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain.
Voltage-sensitive calcium channel conductance is essential for the nervous system to signal a painful event. However, intrathecal administration of L-type calcium channel blockers does not provide analgesia. The present investigation was designed to assess the safety and analgesic efficacy of ziconotide, a new N-type calcium channel blocker, when administered intrathecally to patients with acute postoperative pain. ⋯ Ziconotide showed analgesic activity, as shown by decreased PCA morphine equivalent consumption and lower VASPI scores. Because of a favorable trend of decreased morphine consumption with an acceptable side-effect profile in the low-dose ziconotide group, 0.7 microg/h may be closer to the ideal dose than 7 microg/h. Large-scale studies are required to clarify this issue.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialA randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents.
Pain and gastrointestinal dysfunction are primary factors that delay recovery after posterior spinal fusion. Previous reports suggest that the choice of analgesic management may effect the course of recovery. This prospective, randomized study compared continuous thoracic epidural analgesia and patient-controlled analgesia in the postoperative care of adolescents undergoing posterior spinal fusion for idiopathic scoliosis. ⋯ Continuous epidural analgesia and patient-controlled analgesia are comparably effective and safe after posterior spinal fusion. Return of bowel sounds occurred significantly more rapidly in patients receiving CEA postoperatively.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture.
Combined spinal epidural anesthesia (CSEA) involves the epidural administration of local anesthetic and opioid solutions adjacent to the prior dural puncture, potentially increasing their diffusion into the subarachnoid space. This study was designed to evaluate the influence of dural puncture on the adequacy and extent of analgesia, and drugs requirements of patient-controlled epidural analgesia (PCEA) in the postoperative period. ⋯ Dural puncture with a 25-gauge Quincke needle, performed as part of CSEA, does not influence the drug requirements when a combination of 0.1% bupivacaine and fentanyl (3 microg/mL) is used for PCEA after major abdominal surgery.
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Reg Anesth Pain Med · May 2000
Comparative Study Clinical Trial Controlled Clinical TrialLow-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.
The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension. ⋯ Bupivacaine 5 mg + fentanyl 25 microg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.
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Reg Anesth Pain Med · May 2000
Clinical TrialMyofascial pain in patients with postthoracotomy pain syndrome.
Postthoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. However, nonneuropathic pain can also occur following thoracic surgery. We present a series of cases with postthoracotomy pain syndrome in which myofascial pain was thought to be a causative component of postthoracotomy pain syndrome. ⋯ Postthoracotomy pain may result, at least in part, from a nonneuropathic origin (myofascial pain). It is recommended that each patient be examined in detail to determine whether there is a trigger point in a taut muscular band within the scapular region. If found, this point is suggested as a good area for anesthetic injection.