Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2004
Randomized Controlled Trial Clinical TrialPatients' perception of pain during axillary and humeral blocks using multiple nerve stimulations.
Axillary or humeral blocks by multiple nerve stimulation (MNS) are used for ambulatory hand surgery. This double-blind study identified which of the three main components of the procedure (repeated needle passes, local anesthetic injections, or electrical stimulations) is most painful, quantified its intensity, and recorded patients' preferences for a future anesthetic. ⋯ This study found that more axillary-block patients compared with humeral-block patients reported electrical stimulation as the most unpleasant part of the block but failed to detect significant differences in the intensity of the 3 block components (repeated needle passes, local anesthetic injections, and electrical stimulations). Most patients in both groups would accept the same block for future hand operations. Patients were ready for surgery sooner after axillary block, but the clinical importance of this finding is doubtful.
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Reg Anesth Pain Med · Jul 2004
Randomized Controlled Trial Clinical TrialRopivacaine 3.75 mg/ml, 5 mg/ml, or 7.5 mg/ml for cervical plexus block during carotid endarterectomy.
To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of cervical plexus block during carotid endarterectomy. ⋯ The best quality of cervical plexus block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.
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Skeletal muscle toxicity is a rare and uncommon side effect of local anesthetic drugs. Intramuscular injections of these agents regularly result in reversible myonecrosis. The extent of muscle damage is dose dependent and worsens with serial or continuous administration. ⋯ In this respect, the quantitative impact of further mitochondria-mediated pathways--at least in bupivacaine toxicity--is still to be established. Although experimental myotoxic effects are impressively intense and reproducible, only a few case reports of myotoxic complications in patients after local anesthetic administrations have been published. In particular, the occurrence of clinically relevant myopathy and myonecrosis has been described after continuous peripheral blocks, infiltration of wound margins, trigger point injections, and peri- and retrobulbar blocks.
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Reg Anesth Pain Med · Jul 2004
Clinical TrialThe effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin.
The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 microg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. ⋯ We conclude that 1.25 microg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.