Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2003
Clinical TrialEarly experience with continuous cervical paravertebral block using a stimulating catheter.
This study reports our early experience with continuous cervical paravertebral block (CCPVB) using a stimulating catheter for the management of acute pain after shoulder surgery. ⋯ An average of 2 (range 1-7) attempts were needed to advance the catheter while still stimulating the nerve. Average postoperative pain ranged from 0.27 +/- 1.04 cm to 0.78 +/- 1.56 cm (mean +/- SD) on a visual analog scale (VAS) (0-10 cm) for the first 48 hours and 3.8 +/- 2.1 cm and 3.5 +/- 2.4 cm at 60 hours and 14 days, respectively. Patient satisfaction on a VAS of 0 to 5 was 4.19 +/- 1.1, 4.28 +/- 1.01, and 4.69 +/- 1.05 at times 0, 6 hours, and 14 days, respectively. Motor function returned to normal in the fingers within 24 hours and in the shoulder within 60 hours. Complications included Horner's syndrome (40%), dyspnea (8%), superficial skin infection (5%), posterior neck pain (22%), subclavian artery puncture (1%), contralateral epidural spread (4%), and 8% of the patients complained of an unpleasant "dead feeling" of the arm. Ninety-one percent of patients would request CCPVB again for future shoulder surgery. There was no evidence of nerve damage.
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Reg Anesth Pain Med · Sep 2003
Case ReportsUltrasound-guided popliteal block demonstrates an atypical motor response to nerve stimulation in 2 patients with diabetes mellitus.
Nerve stimulation is a useful technique to identify peripheral nerves before blockade. We report 2 cases of the failure of nerve stimulation to accurately localize the sciatic nerve in patients with diabetes mellitus undergoing outpatient foot procedures. We also introduce a novel approach to performing a popliteal fossa block using ultrasound guidance. ⋯ Ultrasound facilitated the accurate localization of the sciatic nerve in 2 patients with diabetes mellitus. Neither patient had a paresthesia or muscle twitch below 2.4 mA. There is theoretical concern that patients with underlying neuropathy, such as patients with diabetes mellitus, may have an altered response to either motor or sensory stimulation.
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Reg Anesth Pain Med · Sep 2003
Clinical TrialPainful paresthesiae are infrequent during brachial plexus localization using low-current peripheral nerve stimulation.
Considerable controversy exists over the relationship of paresthesia to nerve stimulation. The purpose of this study was to determine the frequency with which patients report paresthesia at the point that an acceptable motor response is obtained to low-intensity current electrical stimulation. ⋯ Painful paresthesiae should be infrequent when a low-stimulating current is used to identify the neural components of the brachial plexus and when the block needle is advanced slowly. Low-current intensity nerve stimulation can be used to achieve successful interscalene block with minimal discomfort to the patient.