Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative intra-articular morphine and bupivacaine for pain control after outpatient arthroscopic anterior cruciate ligament reconstruction.
The purpose of this study was to determine whether intra-articular injection of bupivacaine, morphine, or a combination prior to surgery provided pain control after arthroscopic anterior cruciate ligament (ACL) reconstruction. ⋯ Presurgical injection of a solution of 0.25 % bupivacaine, morphine, and epinephrine provided pain control and decreased opioid use in the PACU. Increasing the morphine dose did not improve the clinical result.
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Reg Anesth Pain Med · May 1999
Comparative Study Clinical Trial Controlled Clinical TrialPercutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase.
Percutaneous epidural neuroplasty (epidural neurolysis, lysis of epidural adhesions) is an interventional pain management technique that has emerged over approximately the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain. In addition to local anesthetic and corticosteroid, hypertonic saline (10% NaCl) and hyaluronidase are used for the technique. The objective of this study was to determine if hypertonic saline or hyaluronidase influenced treatment outcomes. ⋯ Percutaneous epidural neuroplasty, as part of an overall pain management strategy, reduces pain (sometimes for over one year) in 25% or more of subjects with radiculopathy plus low back pain refractory to conventional therapies. The use of hypertonic saline may reduce the number of patients that require additional treatments.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialPhrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic.
Interscalene brachial plexus block (ISB) is associated with phrenic block and diaphragmatic paralysis when high volumes (40-50 mL) of local anesthetic are injected. The goal of our study was to test if a low volume of local anesthetic administered while maintaining proximal digital pressure might more selectively block the brachial plexus and decrease the frequency of phrenic nerve block. ⋯ Decreasing the volume of local anesthetic and applying proximal digital pressure to the site of injection is not effective in reducing the cervical block spread and the frequency or intensity of diaphragmatic paralysis during interscalene ISB.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Clinical TrialFrequency of hypotension during conventional or asymmetric hyperbaric spinal block.
The purpose of this randomized, double-blind study was to evaluate if use of an asymmetric spinal block affects the incidence of hypotension during spinal anesthesia. ⋯ Achieving an asymmetric distribution of spinal block by injecting a small dose of 0.5% hyperbaric bupivacaine through a Whitacre spinal needle into patients placed in the lateral position for 15 min reduces the incidence of hypotension during spinal anesthesia.