Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2007
Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine.
Ropivacaine is primarily a local anesthetic, but it also acts as a vasoactive agent. Case reports have described a critical reduction in blood flow when higher concentrations of ropivacaine were used for peripheral-nerve blocks. One hypothesis is that local application of ropivacaine in tissues supplied by end arteries reduces tissue blood flow because of arterial vasoconstriction. ⋯ The application of ropivacaine directly to a rat's tail artery diminished blood flow and lowered regional skin temperature. These effects were dose related. The use of ropivacaine at higher concentrations can, therefore, not be recommended if tissues supplied by end arteries might be affected.
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Reg Anesth Pain Med · May 2007
Randomized Controlled TrialRebound pain scores as a function of femoral nerve block duration after anterior cruciate ligament reconstruction: retrospective analysis of a prospective, randomized clinical trial.
Continuous perineural femoral analgesia has been reported to reduce numeric rating pain scores (NRS, scale 0-10) after anterior cruciate ligament reconstruction (ACLR). In the current study, we determined rebound pain scores in autograft ACLR outpatients after nerve block analgesia resolved. ⋯ In an anesthesia care protocol consisting of spinal anesthesia and multimodal analgesia during and after autograft ACL reconstruction, approximately 33 hours of additional nerve block duration were required to reduce rebound pain scores by one unit. Further study is required to determine rebound pain score differences when other local anesthetics and anesthetic/analgesic plans are being used and when other surgeries are being performed.
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Reg Anesth Pain Med · May 2007
Randomized Controlled TrialA randomized controlled trial of the anticatabolic effect of epidural analgesia and hypocaloric glucose.
The goal of the present study was to investigate whether epidural analgesia exerts a protein-sparing effect after colorectal surgery in the presence of hypocaloric glucose supply initiated with surgical skin incision. ⋯ Epidural analgesia inhibits the increase in whole-body protein breakdown in patients receiving perioperative hypocaloric glucose infusion initiated with surgical skin incision. However, oxidative protein loss, protein synthesis, and glucose metabolism are not affected by epidural analgesia.