Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialEpidural blockade suppresses lipolysis during major abdominal surgery.
The purpose of the study was to investigate the effect of thoracic epidural administration of local anesthetic, i.e., epidural block on perioperative lipolysis. ⋯ Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.
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Reg Anesth Pain Med · Sep 2002
Changes in regional cerebral blood flow in the thalamus after electroconvulsive therapy for patients with complex regional pain syndrome type 1 (preliminary case series).
The aim of the present case series was to examine whether changes in regional cerebral blood flow (rCBF) induced by electroconvulsive therapy (ECT) in the thalamus are related to the efficacy of ECT. Four chronic pain patients with complex regional pain syndrome (CRPS) type-1 (age, 33 to 58 years) who had failed to respond to standard pain treatments received a course of ECT. To investigate the possible mechanisms of the analgesic effect of ECT on chronic CRPS type-1, we measured significant changes in the rCBF of the thalamus using technetium-99m ethyl cysteinate dimer single photon emission computed tomography (99mTc ECD SPECT), before and after ECT and compared these values between responders and nonresponders. ⋯ The results from the SPECT suggest that normalization of the balance of rCBF in the thalamus may be related to the analgesic efficacy of the ECT on CRPS Type-1.
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Reg Anesth Pain Med · Sep 2002
Comment Letter Historical Article"Santayana's prophecy fulfilled" requires a critique.
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Reg Anesth Pain Med · Sep 2002
Case ReportsAnalgesic effects of ketamine ointment in patients with complex regional pain syndrome type 1.
Ketamine hydrochloride (KET), an agent used for general anesthesia, has local anesthetic effects and N-methyl-D-aspartate (NMDA) receptor antagonist action. Because recent studies emphasized the role of peripherally distributed NMDA receptors in processing the nociceptive information, we investigated whether peripheral application of the ointment containing KET is able to attenuate the symptoms of local neuropathic pain. ⋯ Topical application of KET appears to be beneficial for the patients with acute early dystrophic stage of CRPS I because of either its local anesthetic effect or NMDA receptor antagonist action. Patients with chronic atrophic stage of CRPS I and CRPS II patients do not appear to respond to this treatment.
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Reg Anesth Pain Med · Sep 2002
"See one, do one, teach one, have one": a novel variation on regional anesthesia training.
Is it possible to determine the number of nerve blocks needed for residents to become competent in regional anesthesia? Several studies have focused on this question, and the Residency Review Committee (RRC) for Anesthesiology has now defined a "minimum clinical experience" for some aspects of regional anesthesia training. In our experience, personally being a regional block recipient can also serve to enhance training. ⋯ The lessons learned from personally receiving a regional anesthetic are invaluable and can improve the quality of training, as well as the relationship between anesthesiologist and patient.