Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialA low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia.
Unilateral spinal anesthesia may be advantageous, especially in the outpatient setting. A low dose of anesthetic solution, pencil-point needle, low speed of intrathecal injection, and a lateral position have been reported to facilitate the production of unilateral distribution of spinal anesthesia. We compared the effects of plain and hyperbaric bupivacaine in attempting to obtain a unilateral spinal anesthesia for patients undergoing outpatient knee arthroscopy. ⋯ In conclusion, the spinal anesthesia in both groups are suitable alternatives for adult outpatient knee arthroscopies, but hyperbaric bupivacaine provides us with a more unilateral spinal block.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialQuality of analgesia when air versus saline is used for identification of the epidural space in the parturient.
Identification of the epidural space is often performed using the loss-of-resistance technique (LOR), commonly with air or saline. The effect of air or saline on the quality of labor epidural analgesia has not been adequately studied. ⋯ Using 0.9% saline for the LOR technique is associated with better analgesia as compared with air for labor analgesia, and this advantage should be considered when selecting the syringe contents for the LOR technique.
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Reg Anesth Pain Med · Nov 2000
Spread of injectate during C6 stellate ganglion block and fascial arrangement in the prevertebral region: an experimental study using donated cadavers.
The precise fascial space through which the injectate spreads during stellate ganglion block (SGB) remains unclear. Recent studies using magnetic resonance imaging or computed tomography have suggested that the injectate is deposited around and/or within the longus colli muscle during SGB. However, a fascial space, close to the longus colli, is the most likely route of spread. We identified the prevertebral interlaminal space (PVILS), situated between the anterior and posterior laminae of the prevertebral layer of the fascia, as an important route for the spread of the injectate and as a potential pathway to the ganglion. The danger of downward spread of deep infections through this space has previously been recognized. ⋯ These results suggest that the PVILS plays a critical role in the spread of injectate as well as being a potential pathway to the stellate ganglion during SGB.
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Reg Anesth Pain Med · Nov 2000
Comment Letter Comparative StudyRegional anesthesia with ropivacaine.
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Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block. ⋯ SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.