Regional anesthesia and pain medicine
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Baclofen is a GABA(B) agonist that is administered spinally via an implanted drug delivery device to treat spasticity. It has been shown to have powerful antinociceptive effects in experimental animal models at doses that produce little or no motor-blocking effects but has rarely been used as a spinal analgesic agent in patients without spasticity. ⋯ To date, only 3 studies have shown it to be effective in patients with peripheral nociceptive or neuropathic pain mechanisms. Combinations of baclofen and morphine or clonidine are more effective than each drug alone in clinical as well as animal studies.
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Reg Anesth Pain Med · May 2004
Review Comparative StudyPostoperative cognitive function as an outcome of regional anesthesia and analgesia.
It has been suggested that intraoperative neuraxial (spinal, epidural) anesthesia may decrease postoperative cognitive dysfunction when compared with general anesthesia, but the issue remains controversial. We systematically reviewed the data from published studies to determine the effect of intraoperative neuraxial anesthesia versus general anesthesia on postoperative cognitive dysfunction and delirium. ⋯ The use of intraoperative neuraxial anesthesia does not appear to decrease the incidence of postoperative cognitive dysfunction when compared with general anesthesia. There are methodologic and study-design issues present in many studies, and further elucidation of the pathophysiology of postoperative cognitive dysfunction may provide a direction for future studies.
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Reg Anesth Pain Med · May 2004
Percutaneous electrode guidance using the insulated needle for prelocation of peripheral nerves during axillary plexus blocks.
Short reports have noted that percutaneous prelocation is helpful in determining the anatomic course of a peripheral nerve, and, thereby, may serve as a guide for block needle insertion. We prospectively studied percutaneous electrode guidance to assist axillary brachial plexus blocks. ⋯ Percutaneous electrode guidance using the insulated needle enabled clinicians to locate the terminal branches of the plexus in the axilla and appreciate their depth. This method could, therefore, minimize patient discomfort and perhaps the risk of nerve trauma.
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Reg Anesth Pain Med · May 2004
Comparative StudyLocating the target nerve and injectate spread in rabbit sciatic nerve block.
The purpose of this study is to determine how close the needle tip is placed to the target nerve using a nerve stimulator and to determine how far the injectate spreads in percutaneous nerve blocks. ⋯ The target nerve was located within 5 mm from the needle with less than 0.5-mA stimulation current. The injectate spread to more than 20 mm on average even when a small volume (100 microL) of the injectate was injected in rabbit sciatic nerves.