Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
ReviewBeyond opioid patient-controlled analgesia: a systematic review of analgesia after major spine surgery.
Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. ⋯ The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.
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Reg Anesth Pain Med · Jan 2012
Practice GuidelineAmerican Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version.
In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) issued a practice advisory on local anesthetic systemic toxicity (LAST). The executive summary of this work contained a document that was intended to serve as a checklist for the management of LAST. Based on testing the checklist during a simulated episode of LAST, ASRA has issued an updated version that should replace the previous 2010 version. Electronic copies of the ASRA Checklist, suitable for lamination and inclusion in a local anesthetic toxicity kit, are available from the ASRA Web site (www.asra.com).
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Reg Anesth Pain Med · Jan 2012
ED50 of hyperbaric bupivacaine with fentanyl for cesarean delivery under combined spinal epidural in normotensive and preeclamptic patients.
The use of reduced intrathecal doses is advised for spinal anesthesia during cesarean delivery. However, there are inadequate data regarding the minimum effective dose of intrathecal bupivacaine for cesarean delivery. Preeclampsia is caused by an endothelial dysfunction leading to generalized vasoconstriction. Whether this can offset the pregnancy-induced decrease in intrathecal dose requirement caused by epidural venous dilation and consequent thecal compression is not known. There are no data to evaluate the minimum effective dose of intrathecal drug for cesarean delivery in preeclamptic patients. This study aimed to determine the minimum effective dose represented by the ED50 of intrathecal hyperbaric bupivacaine for normotensive and severely preeclamptic patients undergoing elective cesarean delivery. ⋯ When a combined-spinal epidural is planned in normotensive or severely preeclamptic patients for an elective cesarean delivery, the ED50 of intrathecal hyperbaric bupivacaine along with 20 μg of fentanyl is 4.7 mg.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyTriple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block.
Practitioners mix faster-onset, intermediate-duration local anesthetics (LAs) with slower-onset, long-duration LAs to get fast peripheral nerve block (PNB) onset and long duration. We hypothesized that 1.5% mepivacaine (with epinephrine) (mepivacaine) or 1.5% mepivacaine (with epinephrine) mixed with 0.5% bupivacaine (mixed) would reduce PNB sensory onset by 20% or more versus 0.5% bupivacaine alone (bupivacaine). ⋯ Mixing 1.5% mepivacaine (with epinephrine) with 0.5% bupivacaine speeds up PNB sensory (motor) onset compared with 0.5% bupivacaine alone.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyComparison of a single- or double-injection technique for ultrasound-guided supraclavicular block: a prospective, randomized, blinded controlled study.
Despite good success rates reported with ultrasound-guided supraclavicular block using 1 or multiple injections, no consensus exists on the best technique to use. We designed this study to test the hypothesis that a double-injection technique would hasten the onset of sensory block. ⋯ The double-injection technique offers no benefit over a single injection for the performance of an ultrasound-guided supraclavicular block.