Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialInterscalene perineural ropivacaine infusion:a comparison of two dosing regimens for postoperative analgesia.
BACKGROUND AND OBJECTIVS: A continuous interscalene nerve block with a perineural infusion of ropivacaine 0.2% at 8 mL/h has been shown to provide potent analgesia following moderately painful shoulder surgery. However, this high basal rate limits infusion duration for ambulatory patients who must carry the local anesthetic reservoir. We undertook this investigation to determine if the basal rate of an interscalene perineural ropivacaine infusion could be decreased by 50% with a concurrent 200% increase in patient-controlled bolus dose without compromising infusion benefits in ambulatory patients undergoing moderately painful orthopedic shoulder surgery. ⋯ Following moderately painful ambulatory shoulder surgery, decreasing an interscalene perineural ropivacaine 0.2% basal rate from 8 to 4 mL/h provides similar baseline analgesia and lengthens infusion duration, but compromises other infusion benefits.
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Clinical TrialEfficacy of three doses of ketamine with bupivacaine for caudal analgesia in pediatric inguinal herniotomy.
Ketamine administered systemically is a potent analgesic at subanesthetic plasma concentrations. Addition of ketamine to bupivacaine for caudal epidural block significantly prolongs the duration of postoperative analgesia. The purpose of this prospective, randomized double-blind study is to identify the optimal dose of ketamine that produces the maximum duration of caudal analgesia with minimal adverse effects as an adjuvant to bupivacaine for caudal epidural block. ⋯ The optimal dose of ketamine in our study was 0.5 mg/kg added to 0.75 mL/kg bupivacaine 0.25% for caudal epidural block without an increase in side effects.
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Reg Anesth Pain Med · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of lateral popliteal versus lateral midfemoral sciatic nerve blockade using ropivacaine 0.5%.
The midfemoral approach to the sciatic nerve (MF) is a new technique that has been used for postoperative analgesia after knee surgery. The aim of the present study was to compare efficacy, performance time, and patient acceptance of the midfemoral approach to that of the lateral approach at the level of the popliteal fossa (popliteal block [PB]). ⋯ The midfemoral approach to the sciatic nerve for ankle and foot surgery resulted in a reliable anesthetic, comparable to that of the lateral popliteal approach. This technique is simple, safe, and provides postoperative analgesia as effective as that obtained with the lateral approach.
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Reg Anesth Pain Med · Jan 2004
Clinical TrialLower lobe collapse during continuous interscalene brachial plexus local anesthesia at home.
We report a case of pulmonary left lower lobe collapse following an interscalene local anesthetic infusion administered at home. This case highlights the need for patient education and postoperative communication. ⋯ Good communication must be maintained with the patient at all times. Doctors from other specialties may be unaware of the potential complications of an interscalene block.