Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 1999
Randomized Controlled Trial Clinical TrialRetrobulbar/peribulbar block with 0.2% ropivacaine or 1% lidocaine for transscleral cyclophotocoagulation or retinal panphotocoagulation.
Brief analgesia is needed to complete krypton laser cyclophotocoagulation for glaucoma patients and is advantageous in argon laser panphotocoagulation for diabetic retinopathy. We studied whether 0.2% ropivacaine, known for analgesia with minimal motor block or 1% lidocaine, with rapid onset and short duration of action, both supplemented with hyaluronidase, are suitable local anesthetics for retrobulbar/peribulbar block for these procedures. ⋯ According to our preliminary data, neither 0.2% ropivacaine nor 1% lidocaine reached acceptable frequencies of adequate analgesia during transscleral cyclophotocoagulation, while all retinal panphotocoagulations could be completed under the initial block.
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Reg Anesth Pain Med · Jul 1999
Case ReportsLumbar spine pain originating from vertebral osteophytes.
Axial spine pain originates from a number of structures. Putative pain generators include facet joints, intervertebral disks, sacroiliac joints, and myofascial structures. Osteophytes originating from lumbar vertebral bodies in the area of the intervertebral disks may be a source of nociceptive low back pain which may respond to local injection. ⋯ Vertebral osteophytes may be a source of axial spine pain. Injection of painful osteophytes with a local anesthetic and corticosteroid solution may produce pain relief.
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Reg Anesth Pain Med · Jul 1999
Comparative StudyThe endoneurial response to neurolytic agents is highly dependent on the mode of application.
The variability and predictability of neurolytic neural blocks were studied using an experimental rat sciatic nerve model. The goal of the study was to compare endoneurial and clinical responses to commonly used neurolytic agents. ⋯ There were no differences in the effects of clinically used neurolytic agents after intraneural injections. Although the perineurally applied 7% phenol-aqua induced marked endoneural damage, the destructive effect of glycerol and phenol-glycerol injections seemed to be prevented by the perineurium; phenol-glycerol and glycerol treatments induced subperineural damage only after perineural injections. The ability to penetrate the perineurium favors the use of 7% phenol-aqua in peripheral perineural blocks when complete neurolysis is the goal.
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Anesthesiologists are increasingly utilizing the Internet for personal and professional purposes. Without guidance, the task of searching the Internet for information may be time-consuming and frustrating. This article includes a basic introduction to the Internet with suggestions and guidelines for accessing information resources. Future articles will address locating articles about human anatomy, regional anesthesia and pain medicine. ⋯ This is the first in an informal series of articles demonstrating and describing information technology. The articles will include nontechnical information and will detail the experiences and wisdom obtained from experienced anesthesiologists. The series is geared toward the computer novice with interest in regional anesthesia and pain medicine. These articles are also available in full text on the American Society of Regional Anesthesia website (www.asra.com) with links to the websites in the article.
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Reg Anesth Pain Med · Jul 1999
In vivo diffusion-weighted magnetic resonance microscopy of rat spinal cord: effect of ischemia and intrathecal hyperbaric 5% lidocaine.
Pathophysiologic mechanisms underlying persistent neurologic deficits after continuous spinal anesthesia using hyperbaric 5% lidocaine are still not well understood. It has been suggested that high-dose intrathecal lidocaine induces irreversible conduction block and even ischemia in white matter tracts by breakdown of the blood-nerve barrier. In this study, we use diffusion-weighted magnetic resonance microscopy to characterize the effect of intrathecal hyperbaric 5% lidocaine in rat spinal cord. The parameter measured with DWM, is an "apparent diffusion coefficient," (ADC), which can be used to exclude the presence of ischemia. ⋯ Ischemia reduced the ADC in both spinal cord white and gray matter. Hyperbaric 5% lidocaine did not affect the spinal cord ADC during the first 1.5 hours. We suggest that 5% hyperbaric lidocaine does not induce irreversible neurologic deficits by causing spinal cord ischemia.