Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2003
Randomized Controlled Trial Clinical TrialForearm rescue cuff improves tourniquet tolerance during intravenous regional anesthesia.
Tourniquet pain during intravenous regional anesthesia (IVRA) of the upper limb is common and can limit tourniquet inflation time. We hypothesize that a forearm rescue cuff is better tolerated than the traditional rescue cuff of a double-cuff tourniquet. ⋯ A forearm rescue cuff is better tolerated than an arm cuff double tourniquet during IVRA, allowing for longer tourniquet times. It is also associated with lower pain scores and shorter duration of local anesthetic side effects.
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Reg Anesth Pain Med · Mar 2003
Case Reports Clinical TrialContinuous lumbar plexus block: Use of radiography to determine catheter tip location.
The purpose of this article is to document where a lumbar plexus catheter introduced by the posterior approach will track and to evaluate the benefit of using systematic radiographic verification of catheter placement. ⋯ Epidural spread of local anesthetic during lumbar plexus block should be expected to be relatively common. It can be easily identified clinically with fractionated doses of local anesthetic. The catheter tip was identified in the epidural space by radiographic verification in only 1.8% of cases. This expensive procedure is therefore unnecessary except when an unusual location is suspected, but not necessary to confirm a catheter assumed to be correctly positioned.
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Reg Anesth Pain Med · Mar 2003
Case ReportsCentral nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: A report of two cases.
Central nervous system and cardiac toxicity following the administration of local anesthetics is a recognized complication of regional anesthesia. Levobupivacaine, the pure S(-) enantiomer of bupivacaine, was developed to improve the cardiac safety profile of bupivacaine. We describe 2 cases of grand mal seizures following accidental intravascular injection of levobupivacaine. ⋯ Although levobupivacaine may have a safer cardiac toxicity profile than racemic bupivacaine, if adequate amounts of levobupivacaine reach the circulation, it will result in convulsions. Plasma concentrations sufficient to result in central nervous system toxicity did not produce manifestations of cardiac toxicity in these 2 patients.
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Reg Anesth Pain Med · Mar 2003
Clinical TrialIntervertebral epidural anesthesia in 2,050 infants and children using the drip and tube method.
Pediatric epidural anesthesia has increased in popularity in the last 2 decades, but its success rate and the frequency of complications has not been fully elucidated. We therefore reviewed our experience with 2,050 cases of epidural anesthesia in infants and children. ⋯ Intervertebral epidural anesthesia using the "drip and tube" method is safe and practical in infants and children.
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Reg Anesth Pain Med · Mar 2003
Case ReportsHypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery.
Intrathecal morphine has been used for the relief of postoperative pain following cesarean delivery. We report a case of postoperative hypothermia down to 33.6 degrees C associated with excessive sweating in patient undergoing elective cesarean delivery under spinal bupivacaine anesthesia who received intrathecal morphine for postoperative pain management. ⋯ Intrathecal morphine may cause disruption of thermoregulation resulting in hypothermia associated with excessive sweating.