Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2007
Case ReportsDemonstration of the spread of injectate with deep cervical plexus block: a case series.
The authors conducted a scanographic study in order to characterize the local anesthetic spread of injectate resulting from a single-injection technique of deep cervical plexus block. ⋯ The authors showed that deep cervical plexus block was associated with a wide spread of injectate. The data show that the spread of injectate is enclosed within to the prevertebral layer of the deep cervical fascia.
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Reg Anesth Pain Med · Mar 2007
Randomized Controlled TrialPharmacokinetics of levobupivacaine, fentanyl, and clonidine after administration in thoracic paravertebral analgesia.
There is little knowledge of the pharmacokinetics of local anesthetics and adjunctive analgesics after paravertebral blockade. We evaluated the pharmacokinetics of low-dose levobupivacaine, fentanyl, and clonidine after paravertebral analgesia for breast surgery. ⋯ After paravertebral bolus and infusion administration, Cpmax levobupivacaine was within the safe range. Cpmax fentanyl and clonidine were less than the effective levels after IV administration, suggesting that their analgesic effect may be partly attributed to a peripheral mechanism of action.
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Reg Anesth Pain Med · Mar 2007
Spread of injectate associated with radial or median nerve-type motor response during infraclavicular brachial-plexus block: an ultrasound evaluation.
We have compared ultrasound characteristics of spread during infraclavicular brachial-plexus blocks by use of electrically evoked radial-nerve- or median-nerve-type distal motor responses to guide the injection of 30 mL of 1.5% mepivacaine. ⋯ We have demonstrated that as compared with median-nerve-type motor response, injection performed after a radial-nerve-type motor response promoted reproducible and remarkable ultrasound spread characteristics associated with complete sensory block of the 3 cords at 30 minutes.
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Reg Anesth Pain Med · Mar 2007
Minimally invasive retrieval of knotted nonstimulating peripheral nerve catheters.
Continuous peripheral nerve blockade is rapidly becoming the technique of choice for the management of postoperative orthopedic pain. However, the insertion of perineural catheters may be associated with complications, including catheter kinking and knotting. A knotted catheter may be difficult or impossible to remove at the patient bedside, requiring surgical excision under general anesthesia. We describe a previously unreported minimally invasive technique of retrieving knotted peripheral nerve catheters and avoiding the need for surgical intervention. Although the described technique has been used by interventional radiologists for the removal of knotted intravascular devices, it has not been previously described for the retrieval of knotted perineural catheters. ⋯ The knotting of peripheral nerve catheters is a relatively uncommon phenomenon, occurring in only 0.13% of patients. However, because the use of perineural catheters has increased within anesthesia practice, clinicians may begin to encounter these complications with greater frequency. Practitioners should be aware of surgical alternatives, including guided-fluoroscopic techniques, when simple catheter traction or tension proves unsuccessful at the patient bedside.
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Reg Anesth Pain Med · Mar 2007
Electrical stimulation of the epidural space using a catheter with a removable stylet.
Electrical stimulation can be used to verify the location of epidural catheters. With the traditional technique, the latter must be primed with saline to allow for electrical conduction: any air lock will, thus, hinder the flow of current. Therefore, we set out to explore an alternative mode of stimulation by use of a catheter containing a removable stylet. This study examines the reliability of this new technique. ⋯ We conclude that the TheraCath, because of the removable stylet, provides effective electrostimulation of the epidural space. Its use was simple and devoid of complications. Nonetheless, further studies are required before implementing its routine use in clinical settings.