Regional anesthesia and pain medicine
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In this study, we have performed hypogastric plexus block using a posterior transdiscal approach in 20 patients diagnosed with pelvic pain because of cancer. ⋯ Transdiscal approach to the hypogastric plexus appears to be a safe and effective procedure. However, prospective randomized controlled studies comparing different approaches are needed to increase our knowledge of hypogastric plexus block.
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Reg Anesth Pain Med · Jul 2003
Case ReportsShoulder dislocation after infraclavicular coracoid block.
We report a case of shoulder dislocation after a brachial plexus block with a double-injection technique using the infraclavicular coracoid approach. ⋯ When motor block of the muscles of the shoulder occurs after brachial plexus anesthesia, special care must be taken in patient positioning to avoid shoulder dislocation.
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Reg Anesth Pain Med · Jul 2003
Case ReportsEpidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain.
We present a case of intense herpes zoster-related pain and itching in the ophthalmic division of the trigeminal nerve (V1). Successful pain and itch management was achieved after insertion of a high thoracic epidural catheter with a continuous infusion of bupivacaine and clonidine. ⋯ High thoracic epidural infusion of bupivacaine and clonidine was beneficial in relieving neuropathic itch in a patient with acute herpes zoster-related pain in the distribution of the trigeminal nerve.
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Reg Anesth Pain Med · Jul 2003
Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction.
Esophagectomy can be associated with high morbidity and mortality. We present our experience managing these patients using a standardized multimodal approach that emphasizes intraoperative fluid restriction and early extubation. ⋯ Significant reduction in esophagectomy-related morbidity is possible using a standardized multimodal approach in routine clinical practice. Intraoperative fluid restriction may facilitate early extubation and reduce pulmonary complications without compromising renal function. This preliminary observation warrants further study in a randomized clinical trial.
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Postoperative pain is the expected but nonetheless undesirable byproduct of all surgical procedures. Humanitarian concerns and recent quasi-governmental regulations have heightened awareness about the importance of treating postoperative pain. This guideline builds upon the foundation created by the Agency for Health Care Policy and Research guideline published in 1993, highlights changes that have occurred over the past 10 years, and makes recommendations based on the current scientific evidence. In addition, it takes advantage of the versatile information management inherent in a web-based format to make the information readily available. ⋯ This postoperative pain guideline provides readily accessible information and evidence-based guidance to a variety of providers. It highlights deficiencies in our understanding of the pain and recovery processes and how they might guide our choices of postoperative analgesic techniques. In combination with the powerful system-wide data collection capabilities of the VHA, there may be improved understanding of what techniques are useful. Finally, it may lead to the development of reliable, individualized analgesic plans for specific surgical procedures that incorporate the full range of pharmacologic and nonpharmacologic techniques.