Local and regional anesthesia
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Cardiovascular collapse from accidental local anesthetic toxicity is a rare but catastrophic complication of regional anesthesia. The long-acting amide local anesthetics bupivacaine, levobupivacaine and ropivacaine have differential cardiac toxicity, but all are capable of causing death with accidental overdose. In recent times, the chance discovery that lipid emulsion may improve the chance of successful resuscitation has lead to recommendations that it should be available in every location where regional anesthesia is performed. This review will outline the mechanisms of local anesthetic toxicity and the rationale for lipid emulsion therapy.
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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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Regional anesthesia and analgesia have been associated with improved analgesia, decreased postoperative nausea and vomiting, and increased patient satisfaction for many types of surgical procedures. In obstetric anesthesia care, it has also been associated with improved maternal mortality and major morbidity. ⋯ Infection and hemorrhagic complications, particularly with neuraxial blocks, can cause neurological adverse events. More commonly, however, there are no associated secondary factors and some combination of needle trauma, intraneural injection, and/or local anesthetic toxicity may be associated, but their individual contributions to any event are difficult to define.
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To determine the dose of hyperbaric bupivacaine 0.5% required for unilateral spinal anesthesia during diagnostic knee arthroscopy. ⋯ Unilateral sensory and motor block can be achieved with doses of 5 mg and 7.5 mg hyperbaric bupivacaine 0.5% with a stable hemodynamic state. However, 7.5 mg of hyperbaric bupivacaine 0.5% was the dose required for adequate unilateral spinal anesthesia.