Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2003
Randomized Controlled Trial Clinical TrialEffect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy.
To evaluate the effect of a 20- or 60-second instillation period using 0.5% bupivacaine with epinephrine for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy. ⋯ 0.5% Bupivacaine with epinephrine for as short an instillation period as 20 or 60 seconds can provide a good analgesic alternative after herniorrhaphy and hydrocelectomy in pediatric patients. All studied blocks had comparable duration of action.
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Reg Anesth Pain Med · Jan 2003
Comparative Study Clinical Trial Controlled Clinical TrialRestricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block.
The distribution of local anesthetic after different approaches for brachial plexus anesthesia could be responsible for the varying rates of side effects, such as phrenic block, hoarseness, and Horner's syndrome associated with each approach. We compared the distribution of local anesthetic within the neurovascular space in infraclavicular block with that of interscalene and supraclavicular block. ⋯ Spread of the local anesthetic from the infraclavicular space after infraclavicular coracoid block appears to be limited to below the level of the clavicle. Conversely, local anesthetic solution passes below the clavicle in all patients given interscalene or supraclavicular blocks.
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Reg Anesth Pain Med · Jan 2003
Delivery rate accuracy of portable, bolus-capable infusion pumps used for patient-controlled continuous regional analgesia.
Portable patient-controlled pumps used for perineural local anesthetic infusion appear to be gaining acceptance and are used for an increasing number of medically unsupervised ambulatory patients. The infusion rate accuracy and reliability of these pumps, which allow patient-controlled boluses of potentially toxic medication, has not been independently investigated. We performed this laboratory study to define the flow-rate accuracy, reliability, and profiles of various portable bolus-capable infusion pumps and varied several factors that may influence pump performance. ⋯ These results suggest that factors such as flow-rate accuracy and consistency, infusion profile, and temperature sensitivity should be taken into consideration when choosing a portable infusion pump for local anesthetic administration.
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Reg Anesth Pain Med · Jan 2003
Case ReportsSuperior sagittal sinus thrombosis in a patient with postdural puncture headache.
The occurrence of concomitant intracranial pathology in a patient with postdural puncture headache (PDPH) is rare. We present a patient who had a superior sagittal sinus thrombosis in addition to his PDPH. The signs and symptoms of intracranial pathology in patients with dural puncture headache, in addition to their postural headache, are discussed. ⋯ Patients with PDPH have classic postural headache. The occurrence of additional signs and symptoms should alert the clinician to the presence of intracranial pathology. Patients with lymphoblastic lymphoma who had treatment with L-asparaginase and steroid are predisposed to the development of cortical venous thrombosis and may have this syndrome in addition to a dural puncture headache.