Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2016
Case ReportsBilateral Subpectoral Interfascial Plane Catheters for Analgesia for Sternal Fractures: A Case Report.
Sternal fractures occur after deceleration injuries such as falls and road traffic accidents. Recovery from isolated fractures is excellent, but mortality increases dramatically with concurrent chest injuries such as rib fractures and soft tissue injuries. Short-term complications include chest pain, which prevents patients from taking deep breaths and coughing, thereby predisposing them to chest infections. ⋯ The patient was successfully treated with a continuous infusion of local anesthetic into the subpectoral interfascial plane. We also discuss the use and potential benefits of the subpectoral interfascial plane block in the treatment of pain from sternal fractures.
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Reg Anesth Pain Med · Sep 2016
The Effects of Shoulder Rotation on the Acoustic Window for Thoracic Paramedian Epidural Approach in the Lateral Decubitus Position.
The aim of this study was to examine whether shoulder rotation increases the length of the posterior longitudinal ligament (PLL) in the lateral decubitus position. ⋯ Shoulder rotation significantly increased the dimension of the acoustic target window for paramedian thoracic epidural access in the lateral decubitus position at both T6/7 and T9/10 levels. Further clinical studies are needed to investigate the effect of shoulder rotation on thoracic epidural access.
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Reg Anesth Pain Med · Sep 2016
Case ReportsSpinal Cord Stimulation for Treatment of Neuropathic Pain Associated With Erythromelalgia.
Erythromelalgia is a rare disorder associated with neuropathic pain that commonly affects the lower extremities. This pain is often refractory to multimodal treatment. Both pharmacologic management and interventional anesthetic blocks have been used with varying and often limited success. To date, little experience has been gained with the use of spinal cord stimulation in treating pain associated with erythromelalgia. ⋯ Spinal cord stimulation may be a promising treatment of neuropathic pain associated with erythromelalgia.
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Reg Anesth Pain Med · Sep 2016
Comparative StudyRelative Contribution of Adjuvants to Local Anesthetic for Prolonging the Duration of Peripheral Nerve Blocks in Rats.
A chemically compatible, safe 4-drug multimodal formulation of bupivacaine combined with 3 adjuvants (clonidine, buprenorphine, and dexamethasone) has been proposed for long-lasting single-injection peripheral nerve blocks in patients. However, the relative importance of each of the adjuvants of the 4-drug formulation in producing long-lasting nerve blocks has not been determined. The aim of this study in rats was to determine which adjuvants (clonidine, buprenorphine, or dexamethasone) are essential for producing a long-lasting nerve block. ⋯ This animal study confirmed that the 4-drug multimodal formulation proposed for clinical nerve block produces superior duration of action compared to local anesthetic alone. This rat sciatic nerve model also indicated that one of the 3 adjuvants, clonidine, could by itself account for the extended duration of nerve block of bupivacaine.