Regional anesthesia and pain medicine
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Major nerves and vessels run alongside each other in a "neurovascular bundle" kept together by connective tissue that is often referred to by anatomists, surgeons, and anesthesiologists as the "sheath." Our goal was to macroscopically demonstrate the brachial plexus sheath in embalmed and fresh cadaver dissections. ⋯ We observed a macroscopic fibrous structure surrounding the plexus, which was filled with loose connective tissue lacking any apparent organization.
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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 TrialEffect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer.
Surgical stress and general anesthesia suppress immune function. Preemptive epidural analgesia can affect the perioperative immune responses, and influence cancer management. ⋯ Preemptive epidural analgesia is a reasonable approach for potentially controlling perioperative immune function and preventing postoperative pain in patients undergoing cancer surgery.
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Reg Anesth Pain Med · Jan 2008
Randomized Controlled TrialUse of a topical anesthetic cream (EMLA) to reduce pain after hemorrhoidectomy.
Hemorrhoidectomy usually leads to severe postoperative pain that often causes urinary retention. Topical EMLA cream (lidocaine 2.5% and prilocaine 2.5%) has been used extensively in the clinical setting. This prospective study tested the effectiveness of EMLA cream for postoperative pain control after hemorrhoidectomy. ⋯ Topical EMLA cream decreased pain intensity and meperidine requests, reduced the frequency of single catheterizations, and improved patient satisfaction with postoperative pain management after hemorrhoidectomy in adults.