Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2008
Comparative StudyEthnicity and the distance to the epidural space in parturients.
In a pilot study, we previously demonstrated a higher average skin to lumbar epidural space distance (STLESD) in our obstetric population compared with the published literature. Furthermore, we demonstrated differences in STLESD based on ethnicity. The aim of this study was to perform a comprehensive analysis of the STLESD in our patient population by expanding the number of patients and ethnic groups included. ⋯ In this study we found that the STLESD was deeper than what was previously reported in the literature. Furthermore, ethnicity, in addition to BMI, influenced the STLESD.
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Reg Anesth Pain Med · Jan 2008
Continuous peripheral nerve block for postoperative pain control at home: a prospective feasibility study in children.
We assessed the feasibility and efficacy of postoperative pain control by continuous peripheral nerve blockade (CPNB) in children after early home discharge under parental surveillance. ⋯ Shortening hospital stays with the use of at-home CPNB under sole parental supervision is feasible, after selecting children with a suitable family environment.
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Reg Anesth Pain Med · Jan 2008
Randomized Controlled Trial Comparative StudyComparison of the hemodynamic effects of a single 5 mg/kg dose of lidocaine with or without epinephrine for thoracic paravertebral block.
Epinephrine is often added to local anesthetic solutions to minimize and slow the systemic absorption of local anesthetics, and thus reduce the possibility of adverse effects of these drugs. In an earlier study we found that the injection of 5 mg/kg of lidocaine via the paravertebral route depressed myocardial contractility by up to 30%, with practically no changes in heart rate or blood pressure. In the present study we investigated whether these alterations are due to systemic absorption of the local anesthetic, and whether such absorption can be minimized by adding epinephrine to the local anesthetic solution. ⋯ Addition of epinephrine to lidocaine when performing thoracic paravertebral block, attenuates the cardiodepressive effects associated with the systemic absorption of lidocaine and also, as a result of the beta-adrenergic consequences of epinephrine, systemic absorption from the paravertebral space.
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Reg Anesth Pain Med · Jan 2008
Randomized Controlled Trial Comparative StudyEffects of using the posterior or anterior approaches to the lumbar plexus on the minimum effective anesthetic concentration (MEAC) of mepivacaine required to block the femoral nerve: a prospective, randomized, up-and-down study.
To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. ⋯ Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.