Local and regional anesthesia
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Treatment of localized post-traumatic neuropathic pain in scars with 5% lidocaine medicated plaster.
To evaluate the use of 5% lidocaine medicated plaster (LMP) for treating painful scars resulting from burns or skin degloving. ⋯ LMP was useful for treating painful scars with a neuropathic component, producing meaningful reductions in the intensity of pain and painful surface area. This is the first time that a decrease in the painful area has been demonstrated in neuropathic pain using topical therapy, and may reflect the disease-modifying potential of LMP.
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Continuous femoral nerve blocks are a part of the multimodal perioperative anesthetic regimen following total knee replacement. Elicitation of a quadriceps muscle contraction (QC) at placement is desirable. We prospectively evaluated the relationship between elicited motor response and threshold current with block success in situ femoral nerve catheters after total knee replacement. ⋯ The elicited motor response and current threshold from a stimulating femoral catheter measured prior to local anesthetic injection is an important determinant of the success of femoral nerve block following bolus administration.
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Fracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block. ⋯ We were unable to demonstrate a benefit of FNB over IV fentanyl for patient positioning before spinal block. However, FNB can provide postoperative pain relief, whereas side effects of fentanyl must be considered, and analgesic dosing should be titrated based on pain scores. A multimodal approach (FNB + IV fentanyl) may be a possible option.
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Stimulating peripheral nerve catheters have become increasingly popular as part of postoperative multimodal analgesia for total knee arthroplasty. We describe a case of a successful nonsurgical removal of a knotted stimulating femoral nerve catheter after saline expansion of the catheter pocket at the bedside. ⋯ We present a rare case of a knotted stimulating catheter in which the use of a saline bolus to dilate the catheter pocket proved to be successful after other simple methods of catheter removal had failed. Given the simple nature of this technique, it can be attempted at the bedside before more invasive procedures are planned.
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Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronic pain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-containing solutions in refractory head and neck pain patients.