Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Apr 2006
Randomized Controlled Trial[Continuous versus single-dose sciatic nerve block to complement a femoral block after total knee replacement surgery: a randomized clinical trial].
Performing a sciatic nerve block to complement a continuous femoral nerve block for analgesia after total knee arthroplasty is a subject of controversy. We compared the efficacy of a continuous sciatic nerve block to that of a single-dose block of the same nerve combined with a continuous femoral nerve block. ⋯ Twenty-four hours after total knee replacement surgery, better analgesia was achieved with a continuous sciatic nerve block than with a single-dose block combined with a continuous femoral nerve block.
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Rev Esp Anestesiol Reanim · Apr 2006
[Accidental dural puncture during epidural injection of corticosteroids: a different approach?].
We report 6 cases diagnosed with accidental dural puncture after epidural injection of corticosteroids for low back pain. All the patients reported postdural puncture headache during their stay in the postanesthetic recovery unit. For 3 patients, pain resolved with treatment given in the recovery unit. ⋯ In the last patient, a blood patch was used to treat incapacitating headache 22 days after the epidural procedure and mild analgesics were needed for 4 more weeks. It is important to establish a protocol for treating postdural puncture headache in pain clinics to facilitate decision making. Good physician-patient communication is necessary to avoid refusals for permission for other epidural techniques and to facilitate management of symptoms.
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Recent years have brought renewed interest in peripheral nerve blocks as new drugs and materials have become available and as the advantages of such blocks over other anesthetic and analgesic techniques have been demonstrated. We conducted a literature search in PubMed, the Cochrane Library Plus (Spanish version), and Healthgate for the period January 1, 2000 through October 15, 2005 using the key words "complication and peripheral nerve block," "complication and peripheral block anaesthesia," and "complication and plexus anaesthesia." Totals of 178, 109, and 145 titles were obtained with each portal. When the search was limited to reviews, clinical trials, and randomized controlled trials, the numbers of articles from each portal became 11, 20, and 10, respectively, for the first string of key words; 0, 8 and 6, respectively, for the second string; and 10, 40 and 16 for the third. ⋯ Most of these publications agree that the overall incidence of complications related to these techniques is low. If practice guidelines and algorithms from experts are followed the incidence can be reduced. The aim of this review is to give an updated report of complications related to peripheral nerve blocks.