Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialClonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine.
Both clonidine and ketamine have been found to prolong the action of local anesthetics through a peripheral mechanism. Our study compares the efficacy of a low dose of clonidine or ketamine separately added to intravenous regional anesthesia (IVRA) with lidocaine to prevent tourniquet pain. ⋯ The addition of clonidine 1 microg/kg or ketamine 0.1 mg/kg to lidocaine for IVRA delays the onset of unbearable tourniquet pain and decreases analgesic consumption for tourniquet pain relief, although ketamine has a more potent effect.
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Reg Anesth Pain Med · Nov 2001
Clinical TrialVibration sense testing with a 128-Hz tuning fork as a tool to determine recovery from epidural neuraxial block.
Vibration sense testing using a 128-Hz tuning fork is a commonly used test in the diagnosis of dorsal horn dysfunction and polyneuropathy. In this open, prospective study, we tested the hypothesis that vibration sense testing is a sensitive and specific method to assess recovery from epidural block. ⋯ Based on our observations, recovery of vibration sense corresponds with recovery of motor block after epidural anesthesia and may serve as an easy means of documenting recovery with a single test before discharge.
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Reg Anesth Pain Med · Nov 2001
Randomized Controlled Trial Clinical TrialA paravenous approach for the saphenous nerve block.
This study assesses a paravenous approach for saphenous nerve block at approximately the level of the tibial tuberosity, and compares it with the conventional technique of blind subcutaneous infiltration between the tibial tuberosity and the gastrocnemius muscle. ⋯ The saphenous nerve can be blocked effectively by a paravenous approach using only 5 mL of local anesthetic solution. This approach is advantageous because of its easily identifiable landmark.
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Reg Anesth Pain Med · Nov 2001
Case ReportsContinuous brachial plexus block at the cervical level using a posterior approach in the management of neuropathic cancer pain.
Neuropathic cancer pain due to tumor growth near the brachial plexus is often treated with a combination of nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, anticonvulsants, and oral or transdermal opioids. We propose placement of a catheter along the brachial plexus using a posterior approach for patients not responding to the above-mentioned treatment. ⋯ Continuous brachial plexus block should be considered in patients with severe neuropathic cancer pain in the arm and shoulder. To achieve sufficient pain relief for prolonged periods of time, a catheter was inserted to block the brachial plexus using a posterior approach. This technique may be a valuable alternative to the interscalene approach because of the improved fixation of the catheter in the muscle sheet of the trapezius, splenius cervicus, and levator scapulae muscles, and the decreased likelihood of catheter dislodgment during neck movements.
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Reg Anesth Pain Med · Nov 2001
Randomized Controlled Trial Clinical TrialEffects of epidural anesthesia on thermal sensation.
Epidural anesthesia decreases the core temperatures triggering vasoconstriction and shivering, presumably by increasing apparent (as opposed to actual) lower-body temperature. We therefore tested the hypothesis that epidural anesthesia also increases the overall perception of warmth. ⋯ Thermal sensation with and without epidural anesthesia was comparable at a lower-body temperature near 34 degrees C, which is a normal leg skin temperature. This suggests that autonomic and behavioral thermoregulatory consequences of epidural anesthesia differ-or that the current explanation for reduced vasoconstriction and shivering thresholds during epidural anesthesia is incorrect.