Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2007
Randomized Controlled TrialNausea, vomiting, sleep, and restfulness upon discharge home after outpatient anterior cruciate ligament reconstruction with regional anesthesia and multimodal analgesia/antiemesis.
We analyzed discharge outcome data after anterior cruciate ligament reconstruction (ACLR) under spinal anesthesia including a perineural femoral catheter and multimodal analgesia/antiemesis. The outcomes specifically addressed in this report are nausea, vomiting, and retching (NVR) and quality of sleep/difficulty falling asleep/daytime restfulness. ⋯ NVR and quality of sleep-restfulness after the described regional anesthetic with multimodal analgesia and antiemesis is reported. Smoking status was not a predictor of NVR, and gender and opioid consumption were not consistently predictive of NVR. The addition of a femoral nerve block to the described multimodal technique was not associated with NVR or quality of sleep-restfulness.
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Reg Anesth Pain Med · May 2007
Ultrasound-guided obturator nerve block: a preliminary report of a case series.
Obturator-nerve block improves analgesia for knee surgery. Traditional techniques rely on surface landmarks, which can be variable and result in excessive performance times and multiple needle passes. The objective of this study was to evaluate a novel ultrasound-guided technique for localizing the obturator nerve. ⋯ These preliminary data suggest that ultrasound-guided obturator-nerve identification and block are technically easy and highly successful.
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Reg Anesth Pain Med · May 2007
Clinical TrialHigh-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy.
High-resolution ultrasound imaging (HRUI) allows real-time visualization of peripheral nerves, needle insertion, and the spread of local-anesthetic (LA) solution. We evaluated the feasibility of performing a high interscalene brachial-plexus block for carotid endarterectomy by means of HRUI, thereby limiting the amount of LA to the dose required to sufficiently surround the relevant nerve structures. ⋯ High-resolution ultrasonic imaging allows clear depiction of the target tissues and facilitates accurate needle placement during high interscalene brachial-plexus blocks. This technique may minimize the risk of direct puncture-related complications, as well as accidental intravascular injection of LA. The observation of LA spread in all patients, even in small increments of less than 1 mL might enhance safety by limiting the injected LA to the actual demand. Well-placed LA spread could potentially avoid central nervous toxicity caused by intravascular injection or resorption of inadequately high dosages, in particular in nerve blocks of the highly vascularized neck region.
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Reg Anesth Pain Med · May 2007
Ultrasound-guided and CT-navigation-assisted periradicular and facet joint injections in the lumbar and cervical spine: a new teaching tool to recognize the sonoanatomic pattern.
The aim of this study is to provide a teaching tool to facilitate the acquirement of periradicular and facet-joint infiltration techniques in the cervical and lumbar spine. ⋯ This teaching tool provides immediate CT-verification of sonographically identified structures and helps in the identification of bony landmarks, which are necessary for facet-joint and periradicular injections.
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Reg Anesth Pain Med · May 2007
Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine.
Ropivacaine is primarily a local anesthetic, but it also acts as a vasoactive agent. Case reports have described a critical reduction in blood flow when higher concentrations of ropivacaine were used for peripheral-nerve blocks. One hypothesis is that local application of ropivacaine in tissues supplied by end arteries reduces tissue blood flow because of arterial vasoconstriction. ⋯ The application of ropivacaine directly to a rat's tail artery diminished blood flow and lowered regional skin temperature. These effects were dose related. The use of ropivacaine at higher concentrations can, therefore, not be recommended if tissues supplied by end arteries might be affected.