Regional anesthesia and pain medicine
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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
Case ReportsCervical epidural analgesia via a thoracic approach using nerve stimulation guidance in an adult patient undergoing elbow surgery.
This case report describes the placement of a cervical epidural catheter via the thoracic approach, using nerve stimulation, in a patient undergoing elbow surgery. ⋯ This case report suggests that electrical stimulation may allow one to accurately position epidural catheters in the central neuraxial space to provide reliable, effective analgesia of the upper extremity. This approach might be an alternative way to deliver cervical epidural analgesia for patients undergoing upper extremity surgery.
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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.
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Reg Anesth Pain Med · Jul 2004
Case ReportsPiriformis syndrome in a patient after cesarean section under spinal anesthesia.
The diagnosis, pathogenesis, and treatment of piriformis syndrome as a cause of persistent buttock and hip pain after spinal anesthesia are presented in this case report. ⋯ Back pain with radiation into the buttocks after spinal anesthesia is frequently attributed to the spinal procedure itself. However, prolonged sitting and weight bearing in the upright position after cesarean delivery can cause sciatic nerve compression at the sacroiliac joint with concomitant irritation, inflammation, and spasm of the piriformis muscle. Piriformis syndrome is frequently underdiagnosed in the obstetric population. Because the diagnosis of piriformis syndrome is based mainly on clinical signs and symptoms, the clinician must have a high index of suspicion.