Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyComparative study of ropivacaine 0.5% and levobupivacaine 0.33% in axillary brachial plexus block.
The aim of this prospective, randomized, double-blind study was to compare the block induced by ropivacaine 0.5% with levobupivacaine 0.33% at the recommended dose range in upper limb surgery. These concentrations have provided equivalent block after epidural analgesia. We hypothesized that the block induced by both local anesthetics at clinical equipotent dose would be similar in axillary block. ⋯ Onset of motor block was significantly faster for ropivacaine than levobupivacaine (P = 0.02), but the time to be ready for surgery was similar with both drugs. Duration of sensory block was prolonged with levobupivacaine (P = 0.01).
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Multicenter Study Comparative StudyEffect on neurostimulation of injectates used for perineural space expansion before placement of a stimulating catheter: normal saline versus dextrose 5% in water.
We clinically assessed the electrophysiologic effect of dextrose 5% in water (D5W) and of normal saline (NS) used for expansion of the perineural space before placing a stimulating catheter. We questioned if higher current was required with NS but not with D5W, as has been observed experimentally. ⋯ The current needed to electrostimulate the femoral or sciatic nerve was higher after injection of NS than after D5W.
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Reg Anesth Pain Med · Sep 2009
Anatomic basis to the ultrasound-guided approach for saphenous nerve blockade.
Successful blockade of the saphenous nerve using surface landmarks can be challenging. We evaluated the anatomic basis of performing a saphenous nerve block with ultrasound (US) using its relationship to the saphenous branch of descending genicular artery, sartorius muscle, and the adductor hiatus as defined by cadaveric measurements. ⋯ The US-guided approach for saphenous nerve blockade using its close anatomic relationship to the SBDGA is a feasible alternative to previously described surface landmark-based or US-guided paravenous approaches.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyPercutaneous upper thoracic radiofrequency sympathectomy in Raynaud phenomenon: a comparison of T2/T3 procedure versus T2 lesion with phenol application.
Percutaneous radiofrequency (RF) thoracic sympathectomy is an alternative method to surgical procedures for the treatment of acral ischemia in Raynaud phenomenon. The procedure is indicated if conservative therapy fails to provide sufficient relief. The aim of this study was to compare classic T2 and T3 RF thermolesioning with a less invasive procedure at the level of T2 only. ⋯ Thoracic RF upper sympathectomy is an effective method in the treatment of resistant forms of Raynaud phenomenon. A single-shot procedure at the level of T2 may be preferable because of the shorter procedure duration of this technique.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled TrialDoes local anesthetic dilution influence the clinical effectiveness of multiple-injection axillary brachial plexus block?: a prospective, double-blind, randomized clinical trial in patients undergoing upper limb surgery.
The relationship between the dose, volume, and concentration of local anesthetic and the quality and success of regional anesthesia remains unclear. Our aim was to test whether using 3 different volumes of the same local anesthetic dose influences the success rate of an axillary brachial plexus block with a multiple-injection technique in patients undergoing upper limb surgery. ⋯ An axillary brachial plexus block induced with a multiple-injection technique with mepivacaine 400 mg yields a high success rate regardless of the volume of anesthetic injected.