Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2001
Effects of adrenergic agonists and antagonists on tetrodotoxin-induced nerve block.
The relative contributions of alpha(1)-, alpha(2)-, and beta-adrenergic receptors to adrenergic agonists' prolongation of nerve block by tetrodotoxin (TTX) are unknown. We investigated which receptor agonists prolong TTX block, and whether delayed injection of antagonists can interrupt prolonged blocks after coinjection of TTX and agonists. ⋯ TTX block can be prolonged by alpha(1)- and alpha(2)-, but not beta-adrenergic agonists via locally mediated events of relatively brief duration. Delayed injection of adrenergic antagonists does not interrupt the prolonged blocks produced by coinjection of TTX and adrenergic agonists unless administered soon after block is established. Reg Anesth Pain Med 2001;26:239-245.
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Reg Anesth Pain Med · May 2001
Biography Historical ArticleTwo surgeons who popularized spinal anesthesia.
Because of the significant mortality associated with general anesthesia in the early decades of the 20th century, two US surgeons--George Pitkin and Wayne Babcock--suggested suitable alternatives. Believing in the greater manageability and safety of regional and spinal anesthesia, each investigated these techniques, employing them for surgery and went on to popularize the rational use of regional anesthesia. Reg Anesth Pain Med 2001;26:278-282.
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Reg Anesth Pain Med · Mar 2001
Clinical Trial Controlled Clinical TrialDiagnostic lumbosacral segmental nerve blocks with local anesthetics: a prospective double-blind study on the variability and interpretation of segmental effects.
Selective spinal nerve infiltration blocks are used diagnostically in patients with chronic low back pain radiating into the leg. Generally, a segmental nerve block is considered successful if the pain is reduced substantially. Hypesthesia and elicited paresthesias coinciding with the presumed segmental level are used as controls. The interpretation depends on a standard dermatomal map. However, it is not clear if this interpretation is reliable enough, because standard dermatomal maps do not show the overlap of neighboring dermatomes. The goal of the present study is to establish if dissimilarities exist between areas of hypesthesia, spontaneous pain reported by the patient, pain reduction by local anesthetics, and paresthesias elicited by sensory electrostimulation. A secondary goal is to determine to what extent the interpretation is improved when the overlaps of neighboring dermatomes are taken into account. ⋯ Hypesthetic areas determined after lumbosacral segmental nerve blocks show a large variability in size and location compared with elicited paresthesias. Confirmation of an adequately performed segmental nerve block, determined by coexistence of hypesthesia, elicited paresthesias and pain in the presumed dermatome, is more reliable when the overlap of neighboring dermatomes is taken into account.