Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2007
Randomized Controlled Trial Comparative StudyPreliminary evaluation of infraclavicular catheters inserted using ultrasound guidance: through-the-catheter anesthesia is not inferior to through-the-needle blocks.
This prospective study compared the initial block quality and surgical anesthesia rates of ultrasound-guided infraclavicular blocks with local-anesthetic injected through a catheter versus through a needle. We hypothesized that positioning of the catheter immediately posterior to the axillary artery would produce through-the-catheter (TTC) anesthesia with rates of complete block not inferior to through-the-needle (TTN) injection. ⋯ Ultrasound-guided TTC infraclavicular block produced perioperative anesthesia that was not inferior to a TTN technique.
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Reg Anesth Pain Med · Jul 2007
Case ReportsUneventful removal of an epidural catheter guided by impedance aggregometry in a patient with recent coronary stenting and treated with clopidogrel and acetylsalicylic acid.
This report suggests that impedance aggregometry can be helpful to assess optimum time for and minimize the risk of catheter removal during double antiplatelet therapy. ⋯ Balancing the risks of stent occlusion and epidural bleeding, bedside impedance aggregometry helped to identify the optimum time window for epidural catheter removal with the lowest bleeding risk in this patient.
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Reg Anesth Pain Med · Jul 2007
Magnesium sulfate diminishes the effects of amide local anesthetics in rat sciatic-nerve block.
Magnesium sulfate (MgSO(4)) is well known as an antagonist of N-methyl-d-aspartate receptors and was used for intrathecal analgesia a century ago. However, the effects of MgSO(4) combined with local anesthetics (LAs) on peripheral nerves are unclear. We tested the hypothesis that MgSO(4) could be used as an adjuvant to prolong and intensify conduction block by amide-type LAs in a rat sciatic-nerve block model. Further, the mechanism of possible synergy between LAs and MgSO(4) was investigated in whole-cell mode patch-clamp experiments. ⋯ MgSO(4) coadministered with amide-type LAs shortened the duration of sciatic-nerve block in rats. Therefore, it does not seem to be useful as an adjuvant for peripheral-nerve block. The mechanism of this observed antagonism is unclear but appears to be independent of the action of LAs and MgSO(4) at the LA receptor within the Na(+) channel.