Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2007
A modified lateral approach to the sciatic nerve: magnetic resonance imaging simulation and clinical study.
The authors describe a new lateral approach to the sciatic nerve (SN) block in the popliteal fossa by using magnetic resonance imaging (MRI) and assessed its clinical feasibility. ⋯ Based on the MRI images, a needle inserted below the biceps femoris tendon provides an easy access point to the common peroneal and/or the tibial nerve. This modified lateral approach to the SN was easy to perform, had a high success rate, and was without complication in this small cohort.
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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
Correlation between salivary alpha-amylase activity and pain scale in patients with chronic pain.
The visual analog scale (VAS) is commonly used to assess pain intensity. However, the VAS is of limited value if patients fail to reliably report. Objective assessments are therefore clearly preferable. Previous reports suggest that elevated salivary alpha-amylase may reflect increased physical stress. There is a close association between salivary alpha-amylase and plasma norepinephrine under stressful physical conditions. In this study, we have determined the usefulness of a portable salivary alpha-amylase analyzer as an objective biomarker of stress. ⋯ Because there was a significant correlation between VAS pain scale and salivary alpha-amylase, we suggest that this biomarker may be a good index for the objective assessment of pain intensity. In addition, a simple to use portable analyzer may be useful for such assessment.