Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2012
Randomized Controlled Trial Comparative StudyRandomized controlled trial comparing pudendal nerve block under ultrasound and fluoroscopic guidance.
Although fluoroscopy is an established imaging modality for pudendal nerve block, ultrasound (US) technique allows physicians better visualization of anatomic structures. This study aimed to compare the effectiveness and safety between the US- and fluoroscopy-guided techniques. ⋯ Ultrasound-guided pudendal nerve blockade is as accurate as fluoroscopically guided injections when performed by an experienced clinician. However, the former took a longer time to perform.
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Reg Anesth Pain Med · May 2012
Randomized Controlled TrialDistribution patterns, dermatomal anesthesia, and ropivacaine serum concentrations after bilateral dual transversus abdominis plane block.
The ability of transversus abdominis plane (TAP) blocks to anesthetize the upper abdomen remains debatable. We aimed to describe the local anesthetic distribution following ultrasound-guided TAP blocks with repeated magnetic resonance imaging investigations and to relate this to the resulting dermatomal anesthesia. ⋯ Magnetic resonance imaging analysis revealed a significant time-dependent expansion of injectates. Magnetic resonance imaging and the degree of dermatomal anesthesia confirmed that the upper and lateral TAP compartments do not appear to communicate. Separate injections at the upper intercostal and lateral classic TAP plexuses are necessary to block the entire abdominal wall.
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Reg Anesth Pain Med · May 2012
Randomized Controlled TrialEffect of local anesthetic volume (15 vs 40 mL) on the duration of ultrasound-guided single shot axillary brachial plexus block: a prospective randomized, observer-blinded trial.
One of the advantages of ultrasound-guided peripheral nerve block is that visualization of local anesthetic spread allows for a reduction in dose. However, little is known about the effect of dose reduction on sensory and motor block duration. The purpose of the present study was to compare the duration of sensory and motor axillary brachial plexus block (ABPB) with 15 or 40 mL mepivacaine 1.5%. ⋯ In ABPB with mepivacaine 1.5%, reducing the dose from 40 mL to 15 mL (62.5%) shortens the overall duration of sensory and motor block by approximately 17% to 19%, reduces sensory and motor block duration of individual nerves by 18% to 40%, and decreases the time to first request of postoperative analgesia by approximately 30%.
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Reg Anesth Pain Med · May 2012
Biography Historical ArticleCarl Koller, cocaine, and local anesthesia: some less known and forgotten facts.
Modern-day local anesthesia began in 1884 with a discovery by a young unknown ophthalmologist from Vienna named Carl Koller, who placed a cocaine solution on the cornea, thus producing insensibility. The news of his discovery spread throughout the world in less than a month. "Not surprisingly," a controversial priority discussion emerged. ⋯ In addition, Carl Koller's decision to leave Vienna is also surrounded in secrecy. The story surrounding the revelation of the local anesthetic effect of cocaine and the personalities involved is fascinating and relatively unknown.