Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialIncisional morphine has no analgesic effect on postoperative pain following inguinal herniotomy.
Opioids induce antinociceptive effects after peripheral administration in experimental and clinical studies. The results of the clinical studies are conflicting. The objective of this study was to examine a possible analgesic effect of incisionally administered morphine on postoperative pain in patients undergoing inguinal herniotomy during general anesthesia. ⋯ The analgesic effect of a single 5 mg dose of morphine injected in a herniotomy wound is not superior to saline or to morphine given subcutaneously or intravenously.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialEnhancement of analgesic effect of intrathecal neostigmine and clonidine on bupivacaine spinal anesthesia.
Intrathecal administration of neostigmine has been shown to produce analgesia in both animals and humans. The concurrent administration of intrathecal neostigmine and clonidine has been reported to produce no neurotoxicity in sheep. The purpose of the present study was to evaluate the efficacy and safety of the combining intrathecal neostigmine and clonidine for the relief of pain in patients after cesarean delivery. ⋯ Our study showed that the combination of 150 microg i.t. clonidine and 50 microg neostigmine provided longer postsurgical analgesia than with either drug used alone. However, this combination also produced significantly more adverse effects of prolonged motor block and nausea and vomiting. A further study combining the two study drugs but using a lower dose of i.t. neostigmine (e.g., 25 microg) is recommended.
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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
Defining the cross-sectional anatomy important to interscalene brachial plexus block with magnetic resonance imaging.
Interscalene brachial plexus block is a useful technique to provide anesthesia and analgesia for the shoulder and proximal upper extremity. The initial needle direction at the interscalene groove has been described as being "perpendicular to the skin in every plane" (1). A cross-sectional (axial) approach may offer a more easily conceptualized directed needle placement. The purpose of this study is to define the cross-sectional anatomy and idealized needle angles important to interscalene brachial plexus block. ⋯ These findings suggest initial needle placement at the interscalene groove should be angled less perpendicularly relative to the sagittal plane than is often observed. A cross-sectional approach enables more practical visualization of initial needle placement. A more accurate initial needle placement may minimize the number of needle passes necessary to contact the nerve roots, thereby more efficiently obtaining a successful block.
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Reg Anesth Pain Med · Jan 1998
Epidural pressures and spread of 2% lidocaine in the epidural space: influence of volume and speed of injection of the local anesthetic solution.
The impact of epidural pressures on the spread of epidural block is controversial. This study examined the effect of volume and speed of injection of local anesthetics on epidural pressures and the spread of anesthesia. ⋯ The peak epidural pressures correlated with the speed of injection of the lidocaine solution and not with its volume, whereas the remaining epidural pressures correlated with its volume and not with the speed of injection. The extent and duration of the thermal block exhibited a more consistent correlation (inverse and direct, respectively) with the epidural pressures than those of the sensory block.