Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2005
ReviewNo evidence for analgesic effect of intra-articular morphine after knee arthroscopy: a qualitative systematic review.
Intra-articular (IA) injection of morphine has been the subject of many randomized clinical trials (RCTs). Both negative and positive results have been obtained in trials with a preemptive design, and the question of efficacy remains unresolved. Recent RCTs on patients whose inclusion was delayed until a baseline pain of at least moderate intensity was documented have illuminated the pitfalls of IA analgesic trials. Previously published systematic reviews may have included flawed RCTs in the analyses. ⋯ There are few well-controlled RCTs on IA morphine, and the negative trials of higher quality counter the evidence from the numerous positive ones of lower quality. The quality of most published trials is poor, and performing meta-analysis on these data is not meaningful. Properly controlled trials, in which early postoperative pain intensity is documented, suggest that there is no added analgesic effect of IA morphine compared with saline alone.
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Reg Anesth Pain Med · Jan 2005
Case ReportsUnintentional neuromuscular blocking agent injection during an axillary brachial plexus nerve block.
We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block. ⋯ Unintentional injection of atracurium mixed with ropivacaine during axillary brachial plexus block leads to complete body paralysis that requires general anesthesia and mechanical ventilation. Recovery was complete without any neurological sequela. An analysis of the chain of events that led to the error suggests some recommendations to improve our daily practice.
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Reg Anesth Pain Med · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialSpinal 2-chloroprocaine: minimum effective dose.
Recent studies using preservative-free 2-chloroprocaine (2-CP) for spinal anesthesia have shown it to be a reliable short-acting agent in the 30-mg to 60-mg range. Investigations of doses below this range have not been performed. ⋯ Spinal 2-CP 40 mg and 60 mg provide rapid and reliable sensory and motor block. Although the 20-mg and 30-mg doses can produce sensory anesthesia adequate for brief surgical procedures, less motor block and some sacral sparing should be anticipated. Because the 10-mg dose produces only brief and inconsistent sensory anesthesia, it can be considered a no-effect dose.