Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 1998
The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand.
Although an increase in skin temperature of the hand implies sympathetic block after stellate ganglion block (SGB), it does not indicate complete sympathetic block unless accompanied by an absence of sweating because skin temperature may increase even with a partial sympathetic block. This study examined the efficacy of the SGB to block sweating in the hand and to determine if the magnitude of temperature change in the hand is predictive of a negative sweat test. ⋯ Stellate ganglion block often fails to increase skin temperature in the ipsilateral more than the contralateral hand. A value of Di - Dc > or = 2.0 degrees C was a good predictor of a sympathetic block, but was not sufficient to guarantee a complete sympathetic block of the hand after SGB in all cases. An apparently successful SGB as measured by "usual" clinical criteria may not result in a complete sympathectomy of the hand as is often assumed. Therefore, if obtaining a sympathectomy is important for diagnostic or therapeutic purposes, performing a sweat test provides important confirmatory evidence of the genuine success of the sympathetic block.
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Reg Anesth Pain Med · May 1998
The rate of successful reactivation of labor epidural catheters for postpartum tubal ligation surgery.
Epidural catheters placed for analgesia during labor and delivery can be reused in the postpartum period for postpartum tubal ligation anesthesia. This study examined the success rate of such reactivation of epidural catheters. ⋯ Epidural catheters can be reactivated reliably for as long as 24 hours after they are placed.
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Reg Anesth Pain Med · May 1998
Case ReportsPatient-controlled analgesia using ropivacaine via an intrathecal catheter.
A 38-year-old woman presented with severe intractable pain in the sacral and perirectal areas secondary to metastatic stage I.B. squamous cell carcinoma of the cervix. ⋯ The use of ropivacaine in combination with other analgesics, via an intrathecal catheter for patient-controlled analgesia, was an effective treatment for this patient. In the future, ropivacaine administered epidurally or intrathecally alone, or in combination with other analgesics, may become the local anesthetic of choice due to its preservation of motor function. Certainly, further scientific studies are indicated in the cancer patient population.
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Reg Anesth Pain Med · May 1998
Computed tomographic study of lumbar (L3-4) epidural depth and its relationship to physical measurements in young adult men.
This study was performed to devise a method for predicting epidural depth more accurately with a variety of physical measurements not previously studied. ⋯ Addition of the physical parameters such as waist circumference/neck circumference ratio or BMI results in a higher predictive value for epidural depth than use of more traditional physical parameters such as weight/height ratio and/or weight only. The value of Sl-Ep is independent of any physical parameters. Thus, the significant correlation between the physical measurements and the epidural depth seems to be due only to obesity-related factors.