Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2006
Clinical TrialA subgluteal approach to the sciatic nerve in adults at 10 cm from the midline.
In 2003 we introduced the concept of a sciatic nerve block performed in the midgluteal area at a fixed distance from the midline in all adults regardless of gender and/or body size. The anatomic basis for that study suggested that a subgluteal block could also be accomplished in a similar fashion. ⋯ This report shows that a sciatic nerve block can be performed in the subgluteal area at 10 cm from the midline in adult patients of both sexes and various sizes. Anesthesia of the posterior thigh is not consistently accomplished with this approach.
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Reg Anesth Pain Med · May 2006
Comparative StudyWhich spinal cutaneous nociceptive neurons are inhibited by intravenous lidocaine in the rat?
Intravenous lidocaine (IVL) produces analgesia in multiple painful disorders. The neurophysiological effects of IVL are not well defined, but studies in visceral nociceptive systems have shown that IVL has differential effects on subgroups of spinal neurons. The present study determined whether a similar differential effect of IVL occurs in spinal neurons excited by noxious cutaneous stimuli. ⋯ IVL had differential inhibitory effects on 2 spinal cutaneous nociceptive neuron populations. Other drugs could also have differential effects on sensory pathways, suggesting a mechanism whereby certain drugs differentially affect different types of pain.
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Reg Anesth Pain Med · May 2006
Case ReportsCerebellar herniation after cervical transforaminal epidural injection.
The purpose of this study is to inform readers of potential catastrophic complications associated with performing cervical transforaminal epidural steroid injections. ⋯ Although transforaminal epidural steroid injections are an efficacious treatment for radicular syndromes, there can be catastrophic complications. In light of the growing body of similar case reports, further investigation is warranted to establish a safe protocol for the use of this modality.
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Reg Anesth Pain Med · May 2006
Case ReportsEpidural spread after continuous cervical paravertebral block: a case report.
This report illustrates epidural spread after continuous cervical paravertebral block (CCPVB). By fluoroscopy, it also explains the mechanism of the complication. ⋯ Continuous cervical paravertebral block is a relatively new, but generally well-accepted, modality for postoperative pain control after major surgery to the upper limb. Epidural spread is recognized as a complication. In this particular case, medial placement of the catheter was possibly caused by unintentional medial direction of the bevel of the Tuohy needle. Meticulous attention to the direction of the needle bevel and early recognition and management of adverse events are mandatory. The same principles may apply for continuous thoracic, lumbar, and sacral paravertebral blocks.
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Reg Anesth Pain Med · May 2006
Cervical transforaminal injection and the radicular artery: variation in anatomical location within the cervical intervertebral foramina.
Recent articles have detailed the adverse events associated with transforaminal steroid injections into the radicular arteries. Guidelines on strict transforaminal epidural techniques have been described to limit complications. There remains limited information regarding the cervical level of entry, location within the intervertebral foramina, and prevalence of the radicular arteries within the population. ⋯ A larger population is necessary to characterize the range of anatomic variations in arterial supply within the foramina. Available studies support the current technique of fluoroscopic needle insertion. Yet, there is wide anatomic variation in the origin and location of these vessels, and even with strict adherence to technique, it is feasible that a properly placed needle could penetrate a radicular artery.