Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2004
Editorial CommentRestricting spinal block to the operative side: why not?
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialA low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia.
The injection of small doses of local anesthetic solutions through pencil-point directional needles and maintaining the lateral decubitus position for 15 to 30 minutes after the injection have been suggested to facilitate the unilateral distribution of spinal anesthesia. We evaluated the effects of hypobaric and hyperbaric bupivacaine in attempting to achieve unilateral spinal anesthesia for patients undergoing lower limb orthopedic surgery. ⋯ As a result, unilateral spinal anesthesia with hyperbaric and hypobaric bupivacaine provided a rapid motor and sensory recovery and good hemodynamic stability, but more unilateral spinal block was achieved in patients in the hyperbaric group when compared with patients in the hypobaric group.
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialInterscalene perineural ropivacaine infusion:a comparison of two dosing regimens for postoperative analgesia.
BACKGROUND AND OBJECTIVS: A continuous interscalene nerve block with a perineural infusion of ropivacaine 0.2% at 8 mL/h has been shown to provide potent analgesia following moderately painful shoulder surgery. However, this high basal rate limits infusion duration for ambulatory patients who must carry the local anesthetic reservoir. We undertook this investigation to determine if the basal rate of an interscalene perineural ropivacaine infusion could be decreased by 50% with a concurrent 200% increase in patient-controlled bolus dose without compromising infusion benefits in ambulatory patients undergoing moderately painful orthopedic shoulder surgery. ⋯ Following moderately painful ambulatory shoulder surgery, decreasing an interscalene perineural ropivacaine 0.2% basal rate from 8 to 4 mL/h provides similar baseline analgesia and lengthens infusion duration, but compromises other infusion benefits.
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Reg Anesth Pain Med · Jan 2004
Comparative Study Clinical TrialThigh rotation and the anterior approach to the sciatic nerve: a magnetic resonance imaging study.
The anterior approach to the sciatic nerve block may be associated with a high failure rate because the nerve lies posterior to the lesser trochanter of the femur at the level of needle insertion. However, previous work using cadavers demonstrated that internal rotation of the leg renders the nerve more accessible to the anterior approach. ⋯ The results confirm that, as the thigh is moved from an externally to an internally rotated position, the sciatic nerve becomes more accessible by the anterior approach at the level of the lesser trochanter, and the risk of femoral artery or nerve puncture is reduced but not eliminated.