Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2012
Randomized Controlled TrialThe pharmacokinetics and pharmacodynamics of liposome bupivacaine administered via a single epidural injection to healthy volunteers.
The objective of this study was to assess the pharmacokinetics, sensory/motor effects, and safety of epidurally administered liposome bupivacaine versus bupivacaine HCl in healthy volunteers. ⋯ Epidurally administered liposome bupivacaine 266 mg resulted in a longer duration of sensory blockade than liposome bupivacaine 89 or 155 mg or bupivacaine HCl 50 mg. Duration of motor blockade was shorter with liposome bupivacaine 266 mg versus bupivacaine HCl.
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Reg Anesth Pain Med · Nov 2012
Review Meta AnalysisContinuous peripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials.
Many practitioners consider continuous peripheral nerve blocks (cPNBs) to be superior to single-injection peripheral nerve blocks (siPNBs). Several randomized controlled trials have demonstrated improved pain control, patient satisfaction, and other outcomes for patients with cPNBs compared with patients with siPNBs, whereas other trials have not shown significant differences. We sought to clarify any potential advantages of cPNBs over siPNBs. ⋯ Compared with siPNBs, cPNBs were associated with improved pain control, decreased need for opioid analgesics, less nausea, and greater patient satisfaction. The effect of cPNBs on other clinically relevant outcomes, such as complications, long-term functional outcomes, or costs, remains unclear.
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Reg Anesth Pain Med · Nov 2012
Randomized Controlled TrialA 3-dimensional ultrasound study of local anesthetic spread during lateral popliteal nerve block: what is the ideal end point for needle tip position?
Recent clinical trials suggest that subfascial (sometimes termed subepineural) injections result in faster block onset and success compared with conventional techniques. This prospective, randomized, observer-blinded study measured and compared the 3-dimensional spread pattern and volume of perineural local anesthetic (LA) in contact with the sciatic nerve after subfascial versus extrafascial lateral popliteal injections. ⋯ Placement of the needle tip beneath the complex fascial sheath of the sciatic nerve resulted in significantly greater perineural local anesthetic volume following a single-injection lateral popliteal approach at the nerve bifurcation and was associated with greater sensory blockade and a characteristic laminar LA spread pattern.
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Reg Anesth Pain Med · Nov 2012
Three-times-daily subcutaneous unfractionated heparin and neuraxial anesthesia: a retrospective review of 928 cases.
Subcutaneous (SC) unfractionated heparin (UFH) administered 3 times daily (TID) is widely used for venous thromboembolism prophylaxis in the perioperative period. There are no data in the literature regarding the incidence of adverse outcomes with neuraxial analgesia in the setting of this regimen. In this retrospective review, we report the incidence of untoward events related to anticoagulation with SC UFH TID in patients with indwelling epidural catheters. ⋯ Given the rare incidence of neuraxial hematoma, statements regarding the appropriateness of epidural analgesia in the setting of TID SC UFH cannot be made from this limited sample size. At present, information regarding epidural hematoma in the setting of a TID SC UFH dosing regimen does not exist in the literature. Our study represents an initial step in the accumulation of data needed to prove or disprove the safety of this practice.