Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2009
Randomized Controlled TrialKetamine as an adjuvant in lidocaine intravenous regional anesthesia: a randomized, double-blind, systemic control trial.
Ketamine delays and minimizes intraoperative tourniquet pain when added to lidocaine-based intravenous regional anesthesia (IVRA). It is unclear if adding ketamine to the IVRA injectate is more efficacious compared with systemic administration. This study compares intraoperative tourniquet pain, postoperative analgesia, and side effects of systemic versus IVRA ketamine during outpatient hand surgery. ⋯ In comparison to systemic administration, there is no selective benefit to adding ketamine to the IVRA injectate.
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Reg Anesth Pain Med · Mar 2009
Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases.
Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery. ⋯ Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.
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Reg Anesth Pain Med · Mar 2009
Randomized Controlled TrialContinuous femoral nerve block provides superior analgesia compared with continuous intra-articular and wound infusion after anterior cruciate ligament reconstruction.
This prospective, randomized, clinical trial compared pain intensity and analgesic drug consumption after anterior cruciate ligament (ACL) reconstruction with patellar tendon under femoral-sciatic nerve block anesthesia in patients who received either a continuous femoral nerve block (CFNB) or continuous local anesthetic wound and intra-articular infusions. ⋯ Continuous femoral nerve block provides better analgesia than the continuous patellar tendon wound and intra-articular infusions after anterior cruciate ligament reconstruction with patellar tendon.
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Reg Anesth Pain Med · Mar 2009
A prospective, observational study of the relationship between body mass index and depth of the epidural space during lumbar transforaminal epidural steroid injection.
Previous studies have concluded that transforaminal epidural steroid injections (ESIs) are more effective than interlaminar injections in the treatment of radiculopathies due to lumbar intervertebral disk herniation. There are no published studies examining the depth of epidural space using a transforaminal approach. We investigated the relationship between body mass index (BMI) and the depth of the epidural space during lumbar transforaminal ESIs. ⋯ There is a positive association between BMI and transforaminal epidural depth, but not with age, sex, race, oblique angle, or intervertebral level.
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Reg Anesth Pain Med · Mar 2009
Hydrodynamics of the spinal epidural space in pigs: effects of death and exsanguinations.
We have investigated how the vascular components of the spine determine the resistance and capacitance of the spinal epidural space and determined the magnitude of the longitudinal pressure gradient in the space during fluid infusion. ⋯ There is a small longitudinal pressure gradient within the epidural space during fluid infusion. Hence, the major source of resistance occurs where fluid leaves the epidural space. Death reduced resistance, perhaps by depressurizing spinal arteries in the intervertebral foramina, but did not affect capacitance. Blood in epidural veins is a major determinant of late epidural capacitance.