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
Case ReportsComputed tomography images of entrapped epidural catheter.
Knotting and looping of catheters in the epidural space occur rarely. Visualization of a catheter by radiograph or fluoroscopy is not always possible and often inaccurate in locating the knot and/or the loop with precision. We report the case of an entrapped lumbar epidural catheter. Computed tomography (CT) clearly showed a knotted and looped catheter. ⋯ CT is useful in showing an entrapped epidural catheter and the mechanisms of entrapment. Surgery should be considered when gentle traction fails to retrieve the catheter. CT allows the clinician to localize the catheter with accuracy, thus facilitating surgical follow-up.
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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
Biography Historical ArticleEdward Tuohy: the man, his needle, and its place in obstetric analgesia.
The introduction of a needle designed by Ralph Huber and Edward Tuohy made continuous epidural anesthesia for labor possible. Neither the needle nor the regional anesthetic technique evolved in a vacuum; both were the culmination of a range of ideas developed by individuals around the world.
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Reg Anesth Pain Med · Sep 2002
Cyclooxygenase-2 inhibition potentiates morphine antinociception at the spinal level in a postoperative pain model.
After peripheral inflammatory stimuli, spinal cord cyclooyxgenase-2 (COX-2) mRNA and protein levels increase, whereas COX-1 is unchanged. In animal models of inflammatory pain, intrathecal COX-2 selective inhibitors suppress hyperalgesia. However, the role of spinal COX-2 inhibition in postoperative pain is not well elucidated. This study investigates whether a water-soluble COX-2 selective inhibitor, L-745337, can modify allodynic responses in a rat model of postoperative pain. ⋯ These results suggest a spinal interaction of COX-2 inhibition with opiate analgesia may allow a reduction of postoperative pain with lower doses of opiate.