Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2016
Randomized Controlled TrialSystemic Lidocaine Fails to Improve Postoperative Pain, But Reduces Time to Discharge Readiness in Patients Undergoing Laparoscopic Sterilization in Day-Case Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial.
Perioperative systemic lidocaine provides postoperative analgesia, decreases opioid consumption, and facilitates rehabilitation in abdominal surgery. We hypothesized that systemic lidocaine has analgesic effects in women undergoing day-case laparoscopic sterilization. ⋯ In laparoscopic sterilization, systemic lidocaine reduces time to readiness for hospital discharge.
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Reg Anesth Pain Med · May 2016
Randomized Controlled Trial Multicenter Study Comparative StudyA Multicenter Randomized Comparison Between Intravenous and Perineural Dexamethasone for Ultrasound-Guided Infraclavicular Block.
This multicenter, randomized trial compared intravenous (IV) and perineural (PN) dexamethasone for ultrasound (US)-guided infraclavicular brachial plexus block. Our research hypothesis was both modalities would result in similar durations of motor block. ⋯ Compared with its IV counterpart, PN dexamethasone (5 mg) provides a longer duration of motor block, sensory block, and postoperative analgesia for US-guided infraclavicular block. Future dose-finding studies are required to elucidate the optimal dose of dexamethasone.
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Reg Anesth Pain Med · May 2016
The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study.
Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint. ⋯ The results suggest that both the SN and NVM contribute to the innervation of the anteromedial knee joint and are therefore important targets of adductor canal block. Given the site of exit of both nerves in the distal third of the adductor canal, the midportion of the adductor canal is suggested as an optimal site of local anesthetic administration to block both target nerves while minimizing the possibility of proximal spread to the femoral triangle.
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Reg Anesth Pain Med · May 2016
Randomized Controlled TrialDexmedetomidine Dose Dependently Enhances the Local Anesthetic Action of Lidocaine in Inferior Alveolar Nerve Block: A Randomized Double-Blind Study.
Dexmedetomidine (DEX) dose dependently enhances the local anesthetic action of lidocaine in rats. We hypothesized that the effect might also be dose dependent in humans. We evaluated the effect of various concentrations of DEX with a local anesthetic in humans. ⋯ Dexmedetomidine dose dependently enhances the local anesthetic action of lidocaine in humans. Dexmedetomidine at 2.5 ppm produces similar enhancement of local anesthesia effect as addition of 1:80,000 AD.
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Reg Anesth Pain Med · May 2016
Randomized Controlled Trial Multicenter Study Comparative StudyA Randomized Comparison Between Conventional and Waveform-Confirmed Loss of Resistance for Thoracic Epidural Blocks.
Epidural waveform analysis (EWA) provides a simple confirmatory adjunct for loss of resistance (LOR): when the needle tip is correctly positioned inside the epidural space, pressure measurement results in a pulsatile waveform. In this randomized trial, we compared conventional and EWA-confirmed LOR in 2 teaching centers. Our research hypothesis was that EWA-confirmed LOR would decrease the failure rate of thoracic epidural blocks. ⋯ Compared with its conventional counterpart, EWA-confirmed LOR results in a lower failure rate for thoracic epidural blocks (2% vs 24%) in our teaching centers. Confirmatory EWA provides significant benefits for inexperienced operators.