Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Sep 2011
Review Case Reports Comparative StudyStroke, regional anesthesia in the sitting position, and hypotension: a review of 4169 ambulatory surgery patients.
Despite frequent incidence of hypotension, no cases of stroke were observed in this audit of 4,169 shoulder surgeries performed in the beach-chair position. Notably though, 97% of the cases were performed under brachial plexus block with intravenous sedation rather than a general or relaxant technique.
The authors estimate the upper limit incidence of stroke in the sitting position under regional anaesthesia as 1 in 1,429 (0.07%).
summary -
Reg Anesth Pain Med · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyIntraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial.
High-volume local infiltration analgesia (LIA) is widely applied as part of a multimodal pain management strategy in total hip arthroplasty (THA). However, methodological problems hinder the exact interpretation of previous trials, and the evidence for LIA in THA remains to be clarified. Therefore, we evaluated whether intraoperative high-volume LIA, in addition to a multimodal oral analgesic regimen, would further reduce acute postoperative pain after THA. ⋯ Intraoperative high-volume LIA with ropivacaine 0.2% provided no additional reduction in acute pain after THA when combined with a multimodal oral analgesic regimen consisting of acetaminophen, celecoxib, and gabapentin and is therefore not recommended.
-
Reg Anesth Pain Med · Sep 2011
Randomized Controlled Trial Comparative StudyCatheter orifice configuration influences the effectiveness of continuous peripheral nerve blockade.
We investigated perineural catheter threading distance and orifice configuration during continuous interscalene analgesia. ⋯ These results suggest that multiorifice catheters provide superior intermittent bolus continuous peripheral nerve blockade compared with end-hole catheters. For anterolateral approach interscalene catheter placement, there is minimal benefit, either way, to 2.5- or 5-cm blind catheter advancement.
-
Reg Anesth Pain Med · Sep 2011
Randomized Controlled Trial Comparative StudyValue of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial.
Continuous femoral nerve block in patients undergoing total knee arthroplasty (TKA) improves and shortens postoperative rehabilitation. The primary aim of this study was to investigate whether the addition of sciatic nerve block to continuous femoral nerve block will shorten the time-to-discharge readiness. ⋯ A single-injection or continuous sciatic nerve block in addition to a femoral nerve block did not influence time-to-discharge readiness. A single-injection sciatic nerve block can reduce severe pain on the day of the surgery, whereas a continuous sciatic nerve block reduces moderate pain during mobilization on the first 2 postoperative days.