Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2012
Meta AnalysisDose-ranging effects of intrathecal epinephrine on anesthesia/analgesia: a meta-analysis and metaregression of randomized controlled trials.
Intrathecal epinephrine has been examined by clinical studies, but its effects on analgesia/anesthesia outcomes as well as on undesirable adverse effects is not clearly defined. The objective of this study was to examine the effects of intrathecal epinephrine on intrathecal anesthesia/analgesia. ⋯ Intrathecal epinephrine has dose-dependent clinical and adverse effects. Doses of 100 µg or less prolonged sensory and motor block duration but were associated with greater incidence of hypotension or PONV. Intrathecal epinephrine doses greater than 100 µg prolonged sensory and motor block and were not associated with greater incidence of hypotension and PONV.
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Reg Anesth Pain Med · Jul 2012
Multicenter StudyA cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement.
There is a paucity of large multi-institutional surveys to determine the prevalence of and risk factors for persistent pain after total hip (THR) and knee (TKR) replacements. We surveyed a variety of practices and patients and also correlated persistent pain with health-related quality-of-life outcomes. ⋯ Persistent postsurgical pain is common after THR and TKR and is associated with reduced health-related quality of life, although our survey may be biased by the low response rate and retrospective recall bias. Nonmodifiable risk factors may lead to risk stratification. Severity of acute postoperative pain may be a modifiable risk factor.
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Reg Anesth Pain Med · Jul 2012
Randomized Controlled Trial Comparative StudyHemodynamic profile of target-controlled spinal anesthesia compared with 2 target-controlled general anesthesia techniques in elderly patients with cardiac comorbidities.
The impact of anesthesia techniques in patients experiencing hip fracture is controversial. This study compares the effects on blood pressure of 3 anesthesia techniques that are considered safe for the elderly. ⋯ In elderly patients, spinal anesthesia using titrated doses of bupivacaine provided better blood pressure stability than propofol or sevoflurane anesthesia.
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Reg Anesth Pain Med · Jul 2012
Case ReportsEvolving compartment syndrome not masked by a continuous peripheral nerve block: evidence-based case management.
Compartment syndrome is a potentially devastating complication of many orthopedic surgeries. Whether regional anesthesia can delay the diagnosis of compartment syndrome remains a subject of debate. ⋯ Diagnosis depends on close postoperative monitoring of analgesic use and pain trends, and patients with ambulatory catheters require thorough education about compartment syndrome so they can be evaluated in a timely manner. The current literature on compartment syndrome diagnosis and regional anesthesia is limited to case reports and expert opinion, making evidence-based recommendations difficult.
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Reg Anesth Pain Med · Jul 2012
Real-time evaluation of diffusion of the local anesthetic solution during peribulbar block using ultrasound imaging and clinical correlates of diffusion.
The aims of this prospective observational study were to assess the incidence of intraconal spread during peribulbar (extraconal) anesthesia by real-time ultrasound imaging of the retro-orbital compartment and to determine whether a complete sensory and motor block (with akinesia) of the eye is directly related to the intraconal spread. ⋯ Ultrasound imaging provides information of local anesthetic spread within the retro-orbital space, which might assist in the prediction of block success.