Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2006
Single-stimulation, low-volume infraclavicular plexus block: influence of the evoked distal motor response on success rate.
We compared the success rate of single-injection infraclavicular plexus block by using electrically evoked radial, ulnar, or median nerve-type distal motor response to guide the injection of local anesthetic. ⋯ We showed that evoked distal motor response influenced the success rate of single-injection infraclavicular plexus block. The highest success rate was obtained when injection was performed after radial nerve-type motor response.
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Reg Anesth Pain Med · Sep 2006
The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound.
Seeking paresthesia and obtaining a motor response to an electrical stimulus are the two most common methods of nerve localization for the performance of peripheral-nerve blocks. However, these two endpoints do not always correlate, and the actual sensitivity and specificity of either method remains unknown. The objective of this study is to determine the sensitivity of paresthesia and motor response to electrical nerve stimulation as tools for nerve localization when a 22-gauge insulated needle is used for the performance of axillary-nerve block. ⋯ The very different and relatively low sensitivity of either technique may explain, in part, the lack of correlation previously reported between the 2 endpoints.
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Reg Anesth Pain Med · Sep 2006
Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control.
For diagnostic lumbar medial-branch blocks, fluoroscopic guidance is considered mandatory, but this technique comes with radiation exposure. The clinical feasibility of the ultrasound-guided lumbar medial-branch block has been demonstrated. We evaluated the success rate and validity of this new method by use of fluoroscopy controls in patients previously diagnosed with lumbar facet joint-mediated pain. ⋯ Ultrasound-guided lumbar medial-branch blocks can be performed with a high success rate. However, to be completely independent from fluoroscopy controls, this technique requires further studies regarding the detection of intravascular spread.
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Reg Anesth Pain Med · Sep 2006
Local anesthetics in lipid-depot formulations--neurotoxicity in relation to duration of effect in a rat model.
The aim of this study was to investigate the possible local neurotoxicity of a number of lipid-depot formulations of local anesthetics in relation to their duration of action in sciatic-nerve block. ⋯ The findings suggest that depot formulations of local anesthetics with advantageous pharmaceutical and pharmacologic properties can be prepared by use of bupivacaine as the active component and natural lipids as carriers. A favorable balance between effects and toxicity may conceivably be obtained. After supplemental testing in more sensitive models for toxicity, such formulations could be candidates for clinical trials.