Regional anesthesia and pain medicine
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Continuous peripheral nerve block (CPNB) can provide surgical anesthesia, prolonged postoperative analgesia, and acceptable side effects. Despite these advantages, CPNB is not in widespread use. Recently a new CPNB catheter system (Contiplex, B. Braun, Bethlehem, PA) was developed based on an insulated Tuohy needle, which allows for injection of local anesthetic and catheter insertion without disconnection or needle movement. At present, no clinical studies exist describing this system. ⋯ CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects. Reg Anesth Pain Med 2001;26:209-214.
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Reg Anesth Pain Med · May 2001
Effects of adrenergic agonists and antagonists on tetrodotoxin-induced nerve block.
The relative contributions of alpha(1)-, alpha(2)-, and beta-adrenergic receptors to adrenergic agonists' prolongation of nerve block by tetrodotoxin (TTX) are unknown. We investigated which receptor agonists prolong TTX block, and whether delayed injection of antagonists can interrupt prolonged blocks after coinjection of TTX and agonists. ⋯ TTX block can be prolonged by alpha(1)- and alpha(2)-, but not beta-adrenergic agonists via locally mediated events of relatively brief duration. Delayed injection of adrenergic antagonists does not interrupt the prolonged blocks produced by coinjection of TTX and adrenergic agonists unless administered soon after block is established. Reg Anesth Pain Med 2001;26:239-245.
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Reg Anesth Pain Med · May 2001
Biography Historical ArticleTwo surgeons who popularized spinal anesthesia.
Because of the significant mortality associated with general anesthesia in the early decades of the 20th century, two US surgeons--George Pitkin and Wayne Babcock--suggested suitable alternatives. Believing in the greater manageability and safety of regional and spinal anesthesia, each investigated these techniques, employing them for surgery and went on to popularize the rational use of regional anesthesia. Reg Anesth Pain Med 2001;26:278-282.
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Reg Anesth Pain Med · May 2001
Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine.
Fentanyl is used as an additive to prolong intrathecal anesthesia with both lidocaine and low-dose bupivacaine in the outpatient setting to minimize voiding or discharge delays. Pruritus is the most common side effect. When using procaine as a substitute for lidocaine, we perceived an increased frequency and severity of pruritus. We compared prospectively the frequency and severity of itching with combinations of fentanyl with lidocaine, bupivacaine, and procaine. ⋯ Procaine produces a higher frequency of pruritus than that seen with lidocaine-fentanyl combinations and a greater severity of pruritus than seen with lidocaine-fentanyl and bupivacaine-fentanyl spinal anesthesia. Reg Anesth Pain Med 2001;26:252-256.