Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jul 2010
Local anesthetic sciatic nerve block and nerve fiber damage in diabetic rats.
A concern for anesthesiologists is whether local anesthetics are more toxic to peripheral nerves in diabetic patients. A previous study in streptozotocin-induced diabetic rats showed that larger doses of lidocaine produce moderate nerve injury after nerve block in normal rats and worse injury in diabetic rats. However, it is not clear whether a smaller local anesthetic dose that produces negligible nerve fiber damage in normal rats will produce significant nerve damage in diabetic rats and if adding adjuvant drugs modulates this effect. ⋯ The duration of sciatic nerve block with local anesthetics is longer in diabetic compared with nondiabetic rats. A small, but statistically significant, increase in nerve damage occurred in diabetic rats after nerve block with ropivacaine alone or when duration of lidocaine block was extended with clonidine. These findings may have implications for dosing of local anesthetics in diabetic patients undergoing regional analgesia with nerve blocks.
-
Reg Anesth Pain Med · Jul 2010
Case ReportsFunctional deficits after intraneural injection during interscalene block.
We present an occurrence of a severe but transient neurologic complication after intraneural injection during an ultrasound-guided interscalene block. ⋯ Our report suggests that intraneural injection during ultrasound-guided interscalene block carries a risk of neurologic complications.
-
Reg Anesth Pain Med · Jul 2010
Case ReportsNerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block.
Neurologic complications after peripheral nerve blocks (PNBs) are relatively uncommon. It has been postulated that real-time, needle-nerve visualization during ultrasound guided PNBs might further reduce the risk of neurologic or vascular complications. ⋯ Ultrasound guidance should not preclude development of additional monitoring and protocols to decrease the risk of complications with PNBs.
-
Reg Anesth Pain Med · Jul 2010
Comparative StudyThe effect of fluid injection on lesion size during radiofrequency treatment.
Previous ex vivo studies on monopolar radiofrequency have not incorporated the preinjection of fluid before radiofrequency ablation into study design. The objective of this study was to investigate the effects of the preinjection of small volumes of different fluids on lesion dimensions. ⋯ The influence of the composition of the pre-injected fluid should be considered for monopolar radiofrequency ablation. This ex vivo study revealed a simple method to increase monopolar radiofrequency lesion size. Future research is needed to determine the degree of influence of the composition of the fluid on thermal and electrical conductivity.
-
Reg Anesth Pain Med · Jul 2010
Randomized Controlled Trial Comparative StudyProtein balance in nondiabetic versus diabetic patients undergoing colon surgery: effect of epidural analgesia and amino acids.
Surgical injury provokes a stress response that is thought to be pronounced in patients with diabetes mellitus type 2 (DM2) leading to intensified catabolism. The aim of this study was to compare the effects of perioperative epidural analgesia (EDA) versus patient controlled analgesia (PCA) and amino acid infusion on postoperative metabolism in patients with and without DM2. ⋯ A short-term infusion of amino acids reduced protein breakdown, increased protein synthesis, and rendered protein balance positive. This anabolic effect was pronounced in diabetic patients with EDA compared with nondiabetic patients or PCA, respectively, and prevented an undesirable hyperglycemia.