Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2011
Comparative StudyDoppler measurement of the changes of fetal umbilical and middle cerebral artery velocimetric indices during continuous epidural labor analgesia.
Although complications of the epidural technique are known to affect the fetus adversely, there are no data indicating that regional analgesia directly causes harmful effects to the fetus. Our purpose was to determine the effect of epidural labor analgesia on the Doppler velocimetric indices of the uterine and fetal umbilical and middle cerebral arteries. ⋯ These data suggest that although velocimetric indices of the maternal uterine artery are affected by continuous epidural labor analgesia, fetal circulation, as measured by Doppler velocimetric indices, is not altered.
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Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program.
Laparoscopy, thoracic epidural analgesia, and enhanced recovery program (ERP) have been shown to be the major elements to facilitate the postoperative recovery strategy in open colorectal surgery. This study compared the effect of intraoperative and postoperative intravenous (IV) lidocaine infusion with thoracic epidural analgesia on postoperative restoration of bowel function in patients undergoing laparoscopic colorectal resection using an ERP. ⋯ Intraoperative and postoperative IV infusion of lidocaine in patients undergoing laparoscopic colorectal resection using an ERP had a similar impact on bowel function compared with thoracic epidural analgesia.
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Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative StudyS-ketamine modulates hyperalgesia in patients with chronic pancreatitis pain.
Upper abdominal pain is a dominant feature of chronic pancreatitis. A key phenomenon in this context is hyperalgesia, typically associated with N-methyl-d-aspartate receptor activation. This exploratory study evaluates acute effects of S-ketamine, a noncompetitive N-methyl-d-aspartate antagonist, in modulating generalized hyperalgesia in chronic pancreatitis pain. ⋯ S-ketamine infusion is more effective than placebo in increasing PPTs in chronic pancreatitis pain patients immediately after infusion. This effect did not outlast the infusion. Further research is warranted into S-ketamine use for reducing generalized hyperalgesia and chronic pancreatitis pain.
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Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative StudyIs circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block?: A proof-of-concept study.
Ultrasound (US) guidance, in some instances, can increase the success rate and reduce the onset and procedure times for peripheral nerve blockade compared with traditional nerve localization techniques. The presumptive mechanism for these benefits is the ability to accurately inject local anesthetic circumferentially around the target nerve. We aimed to determine whether ensuring circumferential spread of local anesthetic is advantageous for US-guided popliteal sciatic nerve block. ⋯ Ultrasound-guided circumferential injection of local anesthetic around the sciatic nerve at the popliteal fossa can improve the rate of sensory block without an increase in block procedure time or block-related complications compared with a single-location injection technique.
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Reg Anesth Pain Med · May 2011
Comparative StudyUncomplicated removal of epidural catheters in 4365 patients with international normalized ratio greater than 1.4 during initiation of warfarin therapy.
Current guidelines from the American Society of Regional Anesthesia state that an international normalized ratio (INR) of 1.4 is the upper limit of warfarin anticoagulation for safe removal of an epidural catheter. However, these guidelines are based primarily on expert consensus, and there is controversy regarding this recommendation as being "too conservative." ⋯ Our series of 4365 patients had uncomplicated removal of epidural catheters despite INRs ranging from 1.5 to 5.9. Removal was only during initiation of warfarin therapy (up to approximately 50 hrs after warfarin intake) when several vitamin K factors are likely to still be adequate for hemostasis.