Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2010
Ultrasound-guided transversus abdominis plane catheters and ambulatory perineural infusions for outpatient inguinal hernia repair.
Transversus abdominis plane (TAP) blocks anesthetize the lower abdominal wall, and TAP catheters have been used to provide prolonged postoperative analgesia after laparotomy. The use of TAP catheters on an outpatient basis has not yet been described. We present our experience with ultrasound-guided TAP perineural catheter insertion and subsequent management of ambulatory TAP local anesthetic infusions after inguinal hernia repair. ⋯ An ultrasound-guided TAP catheter and ambulatory local anesthetic perineural infusion are a promising option for prolonged postoperative analgesia after outpatient inguinal hernia repair. A posterior insertion permits preoperative placement by keeping the catheter away from the planned surgical field.
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Reg Anesth Pain Med · Nov 2010
Management of chronic upper abdominal pain in cancer: transdiscal blockade of the splanchnic nerves.
The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. ⋯ Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications.
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Reg Anesth Pain Med · Nov 2010
Clinical TrialCan a single dose of 300 mg of pregabalin reach acute antihyperalgesic levels in the central nervous system?
Central spinal cord sensitization can occur during surgery and may lead to persistent pain after surgery. Pregabalin has been shown to decrease central sensitization in experimental pain paradigms, and so the same antihyperalgesic effect of pregabalin may occur during and immediately after surgery. Our study investigated whether a single 300-mg dose of pregabalin in patients has sufficient central nervous system bioavailability to be useful under acute conditions where brain or spinal cord excitability may lead to long-term disease, such as chronic pain. ⋯ Sufficient central nervous system drug concentrations are reached after oral administration of pregabalin, suggesting that postoperative pain hypersensitivity can be reduced. Decreasing this acute brain or spinal cord excitability may prevent chronic pain from developing after surgery.
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Reg Anesth Pain Med · Nov 2010
Comparative StudyComparison of 2% mepivacaine, clipping, and radiofrequency thermocoagulation for duration and magnitude of action in peripheral arterial blood flow induced by sympathetic block in anesthetized dogs.
Thoracic sympathetic block has recently been performed by placement of the clips on the sympathetic chain to interrupt nerve conduction. The aim of this study was to compare clipping with 2% mepivacaine and radiofrequency thermocoagulation for the potency of sympathetic block from the results of the duration and magnitude of the vasodilation effect induced by thoracic sympathetic block in dogs. ⋯ Clipping may have a same potency compared with 2% mepivacaine and a less potency compared with radiofrequency thermocoagulation in thoracic sympathetic block in dogs.