Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2004
Clinical evaluation of a modified posterior anatomical approach to performing the popliteal block.
Tibial and common peroneal nerves can be blocked by the posterior approach to the popliteal fossa. Techniques using fixed measured distances between knee skin crease and puncture point have been described. We report on an approach that is based on manual identification of the apex of the popliteal fossa. ⋯ The modified posterior anatomical approach for popliteal sciatic nerve block is easy to perform, has a high success rate, and has a low complication rate. The location of the needle insertion point is assessed without any measurement, thus avoiding inaccuracies caused by repeated skin-distance measurements.
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Reg Anesth Pain Med · May 2004
Case ReportsSynovial cysts and the lithotomy position causing cauda equina syndrome.
We describe a case of cauda equina syndrome caused by synovial cysts and the lithotomy position. A transurethral resection of the prostate was performed under spinal anesthesia in the lithotomy position. ⋯ We believe that positioning the patient in the lithotomy position narrowed the cross-sectional area of the spinal canal in a patient with a coexisting critically stenosed lumbar spinal canal. The resultant mechanical pressure caused an ischemic compression injury to the cauda equina.
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Reg Anesth Pain Med · Mar 2004
Case ReportsAn unusual case of painful phantom-limb sensations during regional anesthesia.
The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion. ⋯ This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.