Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 1998
Randomized Controlled Trial Comparative Study Clinical TrialA comparative study of low-dose hyperbaric spinal lidocaine 0.5% versus 5% for continuous spinal anesthesia.
Concerns of cauda equina syndrome have discouraged clinicians to use 5% lidocaine for continuous spinal anesthesia. Earlier reports indicated that single-shot spinal lidocaine 0.5% is effective for minor gynecologic and perianal surgery. In the present study, we evaluate the anesthetic and hemodynamic effects of low dose hyperbaric 0.5% lidocaine for continuous spinal anesthesia and compare with those of the 5% lidocaine solution in patients undergoing urologic surgery. ⋯ Continuous spinal anesthesia produced by 0.5% lidocaine with 7.5% dextrose is as effective as that produced by the 5% lidocaine solution in elderly patients undergoing urologic surgery. An initial 30-mg bolus delivered via indwelling subarachnoid catheter was sufficient to achieve surgical anesthesia for approximately 50 minutes in most patients. Hemodynamic effects of the two lidocaine solutions were also comparable.
-
Reg Anesth Pain Med · Mar 1998
Clinical Trial Controlled Clinical TrialSpinal anesthesia with tetracaine in 0.75% glucose: influence of the vertebral interspace used for injection.
The anesthetic behavior and hemodynamic consequences of spinal anesthesia with marginally hyperbaric tetracaine containing a low concentration of glucose injected at two different interspaces were examined and compared with those of conventionally hyperbaric solution. ⋯ A marginally hyperbaric tetracaine solution injected at the L2-L3 interspace with the patient in the lateral position produced greater extent of cephalad spread than that at the L3-L4 interspace. When compared to a conventionally hyperbaric tetracaine solution injected at the L3-L4 interspace, the marginally hyperbaric solution injected at the L2-L3 interspace caused less hemodynamic variability despite similar levels of maximum sensory block.
-
Reg Anesth Pain Med · Mar 1998
Case ReportsPerisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome.
Piriformis syndrome causing sciatica is sometimes refractory to conventional treatments including physical therapy, piriformis injections, and even caudal epidural steroid injections. Surgical release of the piriformis muscle has been described for difficult cases of piriformis syndrome, but is occasionally accompanied by morbidity. Another approach to treating piriformis syndrome is presented. ⋯ Patients with piriformis syndrome who were refractory to conventional treatments but responded to perisciatic injections of steroid are presented.
-
Reg Anesth Pain Med · Mar 1998
Comparative StudyPain evaluation in the intensive care unit: observer-reported faces scale compared with self-reported visual analog scale.
The visual analog scale (VAS) is a simple and sensitive mean of pain assessment. The faces scale is also a simple, self-reporting method for children. Facial signs of pain have not been used to assess pain in postoperative adult patients in the intensive care unit (ICU). ⋯ The faces scale may be useful for pain evaluation in the ICU.
-
Reg Anesth Pain Med · Mar 1998
Case ReportsAsymptomatic profound oxyhemoglobin desaturation following interscalene block in a geriatric patient.
Interscalene block can be chosen for complete anesthesia for shoulder surgery. Phrenic nerve block occurs with almost all interscalene blocks, but is well tolerated in most patients. This may not be the case in selected geriatric patients. ⋯ Ipsilateral phrenic nerve paralysis caused significant respiratory compromise in an elderly patient without known significant pulmonary disease.