Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2006
Fluoroscopically guided epidural block in the thoracic and lumbar regions.
Epidural block in the midthoracic region is difficult, even with fluoroscopically guided methods, because of the inability to view the interlaminar space on radiographs. We have, therefore, proposed fluoroscopically guided epidural block for the midthoracic region, as well as other thoracic and lumbar regions, by use of the pedicle as a landmark to show the height of the interlaminar space. ⋯ This study showed the usefulness of our fluoroscopically guided method for the midthoracic region, and other thoracic and lumbar regions. We propose an alternative method for a blind epidural approach at Th6-7, Th9-10, Th12-L1, or L3-4.
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Reg Anesth Pain Med · Sep 2006
Comparative StudyHealth-related quality of life in sacroiliac syndrome: a comparison to lumbosacral radiculopathy.
This study attempts to assess the intensity and quality of pain and health-related quality of life in patients with sacroiliac syndrome and to compare those constructs to patients with lumbar radiculopathy. ⋯ The results of this study suggest the following: (1) no true difference exists in the health-related quality of life or pain scores/descriptors between patients with SI syndrome or lumbar radiculopathy, or (2) the presence of comorbid spinal conditions confounds the ability of the SF-36 to detect disparities in health-related quality of life among differing etiologies of low-back pain, despite the use of rigorous diagnostic criteria, and/or (3) other factors besides the diagnostic categories of low-back pain (e.g., functional capability, psychological stress) may be primary determinants of health-related quality of life. To our knowledge, no other study has attempted to use the SF-36 to detect differences in health-related quality of life among patients with different spinal diagnoses.
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Reg Anesth Pain Med · Sep 2006
Randomized Controlled TrialEffect of preoperative epidural morphine administration on desflurane requirements during gynecologic surgery.
The goal of this study is to examine the influence of epidural morphine on the end-tidal desflurane concentration titrated to maintain the bispectal index (BIS) values between 40 and 60 during gynecologic surgery. ⋯ Preoperative administration of epidural morphine does not reduce desflurane requirements in patients undergoing gynecologic surgery.
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Reg Anesth Pain Med · Sep 2006
Randomized Controlled TrialNo differences between 20, 30, or 40 mL ropivacaine 0.5% in continuous lateral popliteal sciatic-nerve block.
The aim of this study was to compare the anesthetic and analgesic characteristics of the administration of an initial bolus of 20, 30, or 40 mL of ropivacaine 0.5% through a lateral popliteal sciatic catheter. ⋯ This dose-response study shows that 20 mL of ropivacaine 0.5% injected through an indwelling lateral popliteal catheter is the optimal dose for foot surgery. Higher doses of 30 mL or 40 mL did not provide any further advantage.
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Reg Anesth Pain Med · Sep 2006
Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations.
Lumbar-plexus and sciatic-nerve blocks are commonly combined for lower-extremity anesthesia using large doses of ropivacaine. Limited information is available about the pharmacokinetics of this practice. We analyzed plasma ropivacaine concentrations after single-injection lumbar-plexus blocks with and without sciatic-nerve blocks. ⋯ The results of this study demonstrate that the plasma ropivacaine concentrations increase quicker when a sciatic-nerve block is added to a lumbar-plexus block, but C(max) remains below the toxicity threshold.