Abstract:
BACKGROUND:Although infrequent, subdural block is a complication of epidural anesthesia with obvious implications. Knowledge of the spinal subdural compartment (dura-arachnoid interface) may help elucidate controversies arising from evidence that subdural catheter placement is feasible and may be difficult to identify clinically. METHODS:Samples of arachnoid lamina obtained during in vivo lumbosacral surgery (n = 4) and from cadavers (n = 6) were obtained and prepared for transmission electron microscopy and scanning electron microscopy. Subdural spaces were artificially produced in suitable samples, and an epidural catheter was inserted between the arachnoid and dura to compare the dimensions of meninges in relation to epidural catheters. RESULTS:Scanning electron microscopy of the dural sac showed areas of continuity between the arachnoid lamina and dura mater and other parts with both membranes separated by a subdural space. Transmission electron microscopy allowed the study of such border zones, where alternating cellular and collagen layers could be seen. A layer rich in collagen fibers and some fibroblasts separated arachnoid and neurothelial cells (dural border cells). Few specialized membrane junctions were found among cells adjacent to collagen fibers. Dura mater had an average thickness of 260 to 400 μm, with a dural lamina of approximately 4 to 6 μm. In areas where the arachnoid appeared separated from the dural lamina, its thickness measured 35 to 45 μm. Catheters with a diameter of 700 μm were successfully inserted inside the subdural space, between the dura mater and the arachnoid lamina. CONCLUSIONS:Dura mater and arachnoid layers act as a single unit but may be pulled apart by traction forces during cadaver processing of the dural sac or in vivo placement of catheters. This generates subdural spaces, either parallel or concentric, because of the minimal resistance offered by the tissue, which may be explained by its few specialized membrane junctions.
journal_name
Reg Anesth Pain Medjournal_title
Regional anesthesia and pain medicineauthors
Reina MA,Collier CB,Prats-Galino A,Puigdellívol-Sánchez A,Machés F,De Andrés JAdoi
10.1097/AAP.0b013e31822e0e8csubject
Has Abstractpub_date
2011-11-01 00:00:00pages
537-41issue
6eissn
1098-7339issn
1532-8651journal_volume
36pub_type
杂志文章abstract:BACKGROUND AND OBJECTIVES:This case series assesses the in vivo spread of contrast within the adductor canal in subjects who recently underwent a total knee arthroplasty. A previous analysis of profound leg weakness with a continuous adductor canal revealed contrast spread from the adductor canal to the femoral triangl...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000216
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The acetylcholinesterase inhibitor neostigmine has shown peripherally mediated analgesic action in recent preclinical and clinical studies. The present study investigates the effectiveness of adding neostigmine to a local anesthetic, mepivacaine, in patients receiving axillary brachial plexus ...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1098-7339(99)90005-6
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:We report the first prospective sonoanatomic study in neonates with the aim to perform ultrasonographic-guided epidural catheter placement in this age group. METHOD:One hundred forty-five neonates with a body weight < or =4 kg (0.53-4 kg) were included in this prospective study. The study was divided into 3...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2006.10.008
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Lipid infusion reverses systemic local anesthetic toxicity. The acceptable upper limit for lipid administration is unknown and has direct bearing on clinical management. We hypothesize that high volumes of lipid could have undesirable effects and sought to identify the dose required to kill 50% of the animal...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/aap.0b013e3181c6f5aa
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:This study examined whether perioperative multimodal analgesia (MMA) improves the effectiveness of intravenous nutrition (IVN) as a means of preventing protein wasting following major upper abdominal surgery (UAS). The MMA regimen utilized combined epidural opioid/local anesthetic and the syst...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/rapm.2002.27850
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Histologic evidence of the comparative neurotoxicity of lidocaine, mepivacaine, and prilocaine is incomplete. We compared the intrathecal neurotoxicity in rats among these 3 drugs based on morphologic and neurofunctional findings. METHODS:Rats (n=169) randomly received 0.12 microL/g of 0%, 2%...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2004.06.013
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The incidence of postdural puncture headache (PDPH) after epidural wet tap for obstetric patients may be as high as 75%. We have studied how subsequent placement of a subarachnoid catheter immediately after confirmation of a wet tap, and leaving the catheter in place for 24 hours affects the i...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/s1098-7339(03)00393-6
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation. METHODS:Twenty cervical specimens were harvested from ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000175
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Concern for block-related injury and liability has dissuaded many anesthesiologists from using regional anesthesia for eye and extremity surgery, despite many studies demonstrating the benefits of regional over general anesthesia. To determine injury patterns and liability associated with eye ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.rapm.2008.01.016
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:A sublingual sufentanil tablet is being developed as a potential alternative to intravenous (IV) opioids for the management of postoperative pain. The objective of these studies was to evaluate the pharmacokinetics, efficacy, and safety of sublingual sufentanil tablets for postoperative pain m...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e3182791157
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000687
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Stellate ganglion block (SGB) is one treatment option for human trigeminal nerve injury. The aim of this study was to evaluate the effectiveness of cervical sympathetic ganglia blocks (SB) by comparing the recovery of severed nerves in 2 rat models, treated or not treated by SB. METHODS:The i...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1053/rapm.2002.31206
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:The perception of high resistance during injection of a local anesthetic during regional anesthesia may indicate intraneural injection. Anesthetists' ability to detect high resistance by "syringe feel" has been questioned in the past. The aim of our study was to investigate the anesthetist's ability to detec...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/aap.0b013e3181ac7f38
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Practitioners mix faster-onset, intermediate-duration local anesthetics (LAs) with slower-onset, long-duration LAs to get fast peripheral nerve block (PNB) onset and long duration. We hypothesized that 1.5% mepivacaine (with epinephrine) (mepivacaine) or 1.5% mepivacaine (with epinephrine) mix...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e318236bc30
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:0.1% bupivacaine for obstetric epidural analgesia is given by infusion, using a loading dose of a higher concentration alone or in combination with opioid analgesics. A single dose of 0.1% without any additive for relief of first-stage labor pain has not yet been documented. METHODS:Fifty-eig...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00115550-199823020-00004
更新日期:1998-03-01 00:00:00
abstract::The blood-brain barrier (BBB) describes the unique properties of endothelial cells (ECs) that line the central nervous system (CNS) microvasculature. The BBB supports CNS homeostasis via EC-associated transport of ions, nutrients, proteins and waste products between the brain and blood. These transport mechanisms also...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2020-101403
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Success in performing ultrasound-guided peripheral nerve blockade (PNB) demands sound knowledge of sonoanatomy, good scanning techniques, and proper hand-eye coordination. The objectives of our study were to evaluate whether simulator training aids success of novice operators in ultrasound-gui...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31823dc340
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Central sensitization is often seen in chronic pain. A relevant and potent mechanism of central sensitization is the central integration of nociceptive impulses. Temporal summation in humans and the wind-up process in animals share common features of central integration. This preclinical and c...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31822b0db0
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:We hypothesized that ultrasound-guided wrist blocks may be faster to perform, and may increase success rate, compared with nerve stimulation-guided wrist blocks. METHODS:Sixty patients undergoing ambulatory endoscopic carpal tunnel release were randomly allocated to receive median and ulnar n...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.rapm.2008.01.004
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Cholestasis has been proposed as a side effect of interpleural bupivacaine. Therefore, the effects of various application techniques on liver enzymes were studied following ethics committee approval and informed patient consent. METHODS:Patients following scheduled thoracotomy and laparoscopi...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1098-7339(98)90055-4
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Because of the uncertainty and limitations in available randomized controlled trials, we performed an analysis of the Medicare claims database to determine whether an association exists between postoperative epidural analgesia and mortality. METHODS:A 5% nationally random sample of Medicare beneficiaries fr...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2004.07.002
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:Third occipital nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial,...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31828b25bc
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The duration of nerve block is longer in streptozotocin (STZ)-induced diabetic rats for all local anesthetics (with and without adjuvants) compared with normal rats. Perioperative glycemic control is currently practiced to reduce adverse events in many at-risk patients, especially in diabetic ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e31826742fd
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Transversus abdominis plane (TAP) blocks have been shown to reduce postoperative pain after various abdominal surgical procedures in several studies. The motor nerves of the abdominal wall are located in the same plane as the sensory nerves affected by the TAP block. The aim of this study was ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e3182330b95
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compressi...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1016/j.rapm.2004.01.012
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Ultrasound-guided regional anesthesia is a rapidly growing field. There exists little information regarding the competencies involved with such a practice. The objective of this exploratory study was to characterize the behavior of novices as they undertook the challenges of learning a new tec...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2006.11.006
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:S(-)-Bupivacaine has the pharmacotoxicological advantage over its antipode and racemate. The interaction with lipid membranes was compared between S(-)-, R(+)- and racemic bupivacaine. METHODS:The bupivacaine-induced changes in membrane property were determined by turbidity and fluorescence p...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2007.05.011
更新日期:2008-07-01 00:00:00
abstract:UNLABELLED:Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia-relat...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1097/AAP.0000000000000185
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:This study reports our early experience with continuous cervical paravertebral block (CCPVB) using a stimulating catheter for the management of acute pain after shoulder surgery. METHODS:This prospective observational study presents 256 CCPVB for pain relief after 14 different shoulder operat...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s1098-7339(03)00221-9
更新日期:2003-09-01 00:00:00
abstract::This article qualitatively assesses and summarizes randomized, controlled studies regarding benefits of ultrasound (US) for brachial plexus block and also examines those studies that have compared different brachial plexus block techniques using US.Studies were identified by a search of PUBMED and EMBASE databases usi...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1097/AAP.0b013e3181d25675
更新日期:2010-03-01 00:00:00