Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyEchogenic technology can improve needle visibility during ultrasound-guided regional anesthesia.
Needle tip visualization is fundamental to the safety and efficacy of ultrasound-guided regional anesthesia (UGRA). It can be extremely challenging especially at steep insertion angles. We assessed whether an echogenic needle improved tip visibility during UGRA by anesthesiologists performing their normal in-plane technique. ⋯ Tip visibility with the Sonoplex was independent of insertion angle over the range studied (0-57 degrees, P=0.95). This finding occurred when nonexpert anesthesiologists performed their standard UGRA technique. A needle that is visible for a greater percentage of time has potential safety and efficacy implications.
-
Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyPosterior versus anterolateral approach interscalene catheter placement: a prospective randomized trial.
Two distinctly different approaches to interscalene catheter placement have been in common use for close to a decade. This prospective randomized study tested the hypothesis that interscalene catheters placed using the posterior approach would provide a more effective analgesia after shoulder surgery compared with catheters placed using the anterolateral approach. ⋯ Anterolateral interscalene catheters perform more effectively and are procedurally more easily placed compared with catheters placed using the posterior approach.
-
Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyLong-term pain, stiffness, and functional disability after total knee arthroplasty with and without an extended ambulatory continuous femoral nerve block: a prospective, 1-year follow-up of a multicenter, randomized, triple-masked, placebo-controlled trial.
Previously, we have demonstrated that extending a continuous femoral nerve block (cFNB) from overnight to 4 days after total knee arthroplasty (TKA) provides clear benefits during the infusion, but not subsequent to catheter removal. However, there were major limitations in generalizing the results of that investigation, and we subsequently performed a very similar study using a multicenter format, with many health care providers, in patients on general orthopedic wards, thus greatly improving inference of the results to the general population. Not surprisingly, the perioperative/short-term outcomes differed greatly from the first, more limited study. We now present a prospective follow-up study of the previously published, multicenter, randomized controlled clinical trial to investigate the possibility that an extended ambulatory cFNB decreases long-term pain, stiffness, and functional disability after TKA, which greatly improves inference of the results to the general population. ⋯ This investigation found no evidence that extending an overnight cFNB to 4 days improves (or worsens) subsequent pain, stiffness, or physical function after TKA in patients of multiple centers convalescing on general orthopedic wards.
-
Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of neosaxitoxin versus bupivacaine via port infiltration for postoperative analgesia following laparoscopic cholecystectomy: a randomized, double-blind trial.
Wound infiltration with available local anesthetics generally provides analgesia for less than 8 hrs. The site 1 sodium-channel toxin neosaxitoxin (neoSTX) produced analgesia for over 24 hrs in animals and human volunteers. In this randomized, double-blind trial, we examined the postoperative course of patients undergoing laparoscopic cholecystectomy under a standardized general anesthesia with wound infiltration using either neoSTX or bupivacaine. We hypothesized that neoSTX would reduce pain compared with bupivacaine at 12 hrs postoperatively. ⋯ NeoSTX shows promise as a long-acting local anesthetic. Future studies will examine dose response, combination formulations, and safety with dose escalation.
-
Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyCombined versus sequential injection of mepivacaine and ropivacaine for supraclavicular nerve blocks.
An ideal local anesthetic with rapid onset and prolonged duration has yet to be developed. Clinicians use mixtures of local anesthetics in an attempt to combine their advantages. We tested the hypothesis that sequential supraclavicular injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine speeds onset of sensory block and prolongs duration of analgesia compared with simultaneous injection of the same 2 local anesthetics. ⋯ Sequential injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine provides no advantage compared with simultaneous injection of the same doses.