Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialSensory block extension during combined spinal and epidural.
During a combined spinal and epidural technique, extension of sensory block by epidural injection of saline or bupivacaine has been demonstrated and attributed to a volume effect or to the combination of a volume effect with a local anesthetic effect. This two-part study was designed to evaluate the time dependency of the volume effect and the local anesthetic effect on the mechanism of spinal block extension. ⋯ During a combined spinal and epidural technique with the use of hyperbaric bupivacaine, the volume effect is time dependent and is seen when epidural top up is done soon after spinal injection. This volume effect is abolished when patients are left seated for 5 minutes after spinal injection. The local anesthetic effect is not demonstrated when high sensory block levels are achieved by spinal injection.
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The neurolytic celiac plexus block is an established, well-developed procedure and the most widely applicable of all the neurolytic pain blocks. It optimizes palliative treatment for cancer of the upper abdominal viscera. Several techniques have been proposed in an attempt to increase success rates, reduce morbidity, and enhance technical accuracy. However, the assessment of the results and effectiveness of the block have been controversial. ⋯ Neurolytic celiac plexus block alone is capable of providing complete pain relief until death in a few cases and, therefore, should be considered as an adjuvant treatment in the analgesic strategy. Combination palliative therapy is necessary in most cases. Failure of the block may be attributed to tumor metastasizing beyond the nerves that conduct pain via the celiac plexus and the component nerves that form it. Concomitant pain of somatic origin (frequently observed in upper gastrointestinal cancer because of significant peritoneal involvement) requires other therapeutic measures.
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Reg Anesth Pain Med · Jan 1998
Case ReportsThe use of 5% lidocaine for prolonged analgesia in chronic pain patients: a new technique.
It has been found that 5% lidocaine with 7.5% dextrose causes irreversible conduction block in animal studies. Our case report subjects allowed us to observe the efficacy of 5% lidocaine for a prolonged analgesia in vivo. ⋯ Our observations suggest that 5% lidocaine may be used safely and effectively for the purpose of prolonged analgesia in selected patients with intractable chronic pain syndromes.
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Reg Anesth Pain Med · Jan 1998
The effects and side effects of interscalene brachial plexus block by posterior approach.
To investigate the use of interscalene block by posterior approach in upper extremity surgery and its effects on routine pulmonary function tests. ⋯ Interscalene block by posterior approach did not provide a satisfactory anesthesia for forearm and hand surgery. This method also caused hemidiaphragmetic paresis and a reduction in pulmonary function tests as in the lateral approach of Winnie. We believe limitations and relative contraindications for interscalene block by lateral approach are the same for posterior approach.