Thesis (Ph.D.)--Case Western Reserve University, 2009 / Abstract Department of Biomedical Engineering Title from PDF (viewed on 20 April 2009) Available online via the OhioLINK ETD Center

Hip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.

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名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成4年7月20日 新田弘幸氏の博士論文として提出された

Thesis (M.S.)--University of Wisconsin - Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 75-80).

We performed greater occipital nerve blocks on 24 migraineurs with unilateral migraine and trigeminal nerve distribution allodynia. Using a visual analog scale for migraine pain, brush allodynia in the trigeminal nerve distribution and photophobia were reduced 64%, 75%, and 67%, respectively, after 5 minutes. Allodynia improved faster than headache. The results of this study suggest that greater occipital nerve blocks initiate an inhibitory process that shuts down several symptom generators.

No description available.

Thoracic paravertebral block (TPVB) consists of an injection of local anaesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. Clinically TPVB can be accomplished either as a single-injection or as a multiple-injection. It can also be used as a continuous paravertebral infusion through an indwelling catheter for continuous pain relief. However compared to an epidural block, TPVB is less well understood and not commonly used for anaesthesia and or analgesia in anaesthetic practice. I hypothesized that TPVB is effective for producing unilateral segmental thoracic anaesthesia and managing pain of unilateral origin from the thorax. / The objective of this thesis was to develop the technique of TPVB so that it becomes a useful technique for anaesthesia and pain management. So to test my hypothesis a series of clinical studies were performed on 416 patients (396 adults and 20 young infants), presenting for anaesthesia and or acute pain management, to evaluate various aspects of TPVB, namely; clinical application, anatomy of the thoracic paravertebral space, technique and safety, and pharmacology of local anaesthetic after TPVB. Also included are 9 published case reports and letters-to-editor (Appendix 1-9) based on my research that have provided new insights into the mechanism and applications of TPVB. The following section summarizes my research... / Karmakar, Manoj Kumar. / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 270-285). / Appendix includes Chinese. / ABSTRACT --- p.v / PREFACE --- p.xxvii / STATEMENT OF WORK --- p.xxviii / ACKNOWLEDGEMENTS --- p.xxix / PUBLICATIONS AND PRESENTATIONS --- p.xxxii / LIST OF ABBREVIATIONS --- p.xxxviii / LIST OF TABLES --- p.xli / LIST OF FIGURES --- p.xliii / Chapter Part 1. --- Introduction --- p.1 / Chapter Chapter 1. --- Objective and Plan of Research --- p.2 / Chapter Chapter 2. --- Thoracic Paravertebral Block A Review of the Literature. --- p.7 / Chapter 2.1. --- Introduction --- p.7 / Chapter 2.2. --- History --- p.7 / Chapter 2.3. --- Anatomy: --- p.9 / Chapter 2.4. --- Techniques --- p.17 / Chapter 2.4.1. --- Anatomical Landmark Based Techniques --- p.20 / Chapter 2.4.1.1. --- Loss-of-resistance Technique --- p.20 / Chapter 2.4.1.2. --- Advancing the Block Needle by a pre-determined Distance --- p.23 / Chapter 2.4.1.3. --- Other Landmark Based Techniques --- p.24 / Chapter 2.4.2. --- Fluoroscopic Guidance or Injection of Radiopaque Contrast medium --- p.24 / Chapter 2.4.3. --- Peripheral Nerve Stimulation --- p.25 / Chapter 2.4.4. --- Pressure Measurement Technique --- p.26 / Chapter 2.5. --- Thoracic Paravertebral Catheter Placement --- p.27 / Chapter 2.6. --- Ultrasound Guided Thoracic Paravertebral Block --- p.32 / Chapter 2.6.1. --- Two Dimensional (2D) Sonoanatomy of the Thoracic Paravertebral Region --- p.32 / Chapter 2.6.1.1. --- Basic Considerations --- p.32 / Chapter 2.6.1.2. --- Transverse Scan of the Thoracic Paravertebral Region --- p.33 / Chapter 2.6.1.3. --- Sagittal Scan of the Thoracic Paravertebral Region --- p.42 / Chapter 2.6.2. --- Three Dimensional (3D) Sonoanatomy of the Thoracic Paravertebral Region --- p.46 / Chapter 2.6.3. --- Ultrasound Guided Thoracic Paravertebral Block - Techniques --- p.49 / Chapter 2.6.3.1. --- Transverse scan with short axis needle insertion (Technique 1) --- p.54 / Chapter 2.6.3.2. --- Paramedian Sagittal scan with in-plane needle insertion (Technique 2) --- p.56 / Chapter 2.6.3.3. --- Transverse scan with in-plane needle insertion or the Intercostal approach to the TPVS (Technique 3) --- p.58 / Chapter 2.7. --- Mechanism and Spread of Anaesthesia --- p.58 / Chapter 2.8. --- Indications --- p.65 / Chapter 2.9. --- Contraindications --- p.65 / Chapter 2.10. --- Drugs Used and Dosage --- p.68 / Chapter 2.11. --- Pharmacokinetic Considerations --- p.70 / Chapter 2.12. --- Failure Rate and Complications --- p.72 / Chapter 2.13. --- Clinical Applications of Thoracic Paravertebral Block --- p.76 / Chapter 2.13.1. --- Pain Relief after Thoracic Surgery --- p.76 / Chapter 2.13.2. --- Pain Relief after Multiple Fractured Ribs --- p.78 / Chapter 2.13.3. --- Anaesthesia and Analgesia for Breast Surgery --- p.80 / Chapter 2.13.4. --- Thoracic Paravertebral Block and Chronic Pain after Breast Cancer Surgery --- p.84 / Chapter 2.13.5. --- Thoracic Paravertebral Block and Cancer Recurrence after Breast Cancer Surgery --- p.85 / Chapter 2.13.6. --- Anaesthesia and Analgesia for Inguinal Herniorrhaphy --- p.87 / Chapter 2.13.7. --- Pain Relief after Cholecystectomy and Renal Surgery --- p.90 / Chapter 2.13.8. --- Anaesthesia and Analgesia for Liver and Biliary Tract Surgery --- p.91 / Chapter 2.13.9. --- Analgesia after Cardiac Surgery --- p.92 / Chapter 2.13.10. --- Thoracic Paravertebral Block and Chronic Pain Management --- p.94 / Chapter 2.13.11. --- Bilateral Thoracic Paravertebral Block --- p.94 / Chapter 2.13.12. --- Miscellaneous Applications --- p.95 / Chapter Part 2. --- Studies Evaluating the Efficacy of Thoracic Paravertebral Block in Adults. --- p.96 / Chapter Chapter 3. --- Prospective Randomized Evaluation of the Effects of Combining a Single-injection Thoracic Paravertebral Block with General Anesthesia in Patients Undergoing Modified Radical Mastectomy. --- p.97 / Chapter Chapter 4. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia A Prospective, Randomized, Double Blind, Controlled Trial. --- p.120 / Chapter Chapter 5. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Pain Management in Patients with Multiple Fractured Ribs. --- p.137 / Chapter Chapter 6. --- Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-related Quality of Life after Modified Radical Mastectomy. --- p.154 / Chapter Chapter 7. --- Right Thoracic Paravertebral Anaesthesia for Percutaneous Radiofrequency Ablation of Liver Tumours. --- p.186 / Chapter Part 3. --- Studies Evaluating The Efficacy Of Thoracic Paravertebral Block In Children. --- p.198 / Chapter Chapter 8. --- Continuous Extrapleural Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia in Young Infants. --- p.199 / Chapter Part 4. --- Studies Evaluating The Anatomy Relevant For Thoracic Paravertebral Block. --- p.213 / Chapter Chapter 9. --- Thoracic Paravertebral Sonography - A Quantitative Evaluation of the Paramedian Sagittal Window for Visualizing the Anatomy Relevant for Thoracic Paravertebral Block. --- p.214 / Chapter Chapter 10. --- Volumetric 3D Ultrasound Imaging of the Anatomy Relevant for Thoracic Paravertebral Block. --- p.228 / Chapter Part 5. --- Pharmacokinetics of Ropivacaine after Thoracic Paravertebral Block. --- p.242 / Chapter Chapter 11. --- Arterial and Venous Pharmacokinetics of Ropivacaine With and Without Epinephrine after Thoracic Paravertebral Block. --- p.243 / Chapter Part 6. --- Summary and Conclusions --- p.266 / Chapter Chapter 12. --- Summary and Conclusions --- p.266 / Chapter Part 7. --- Bibliography --- p.270 / Chapter Part 8. --- Appendix --- p.296 / Chapter A. --- Published Case Reports and Letters-to-editor. --- p.297 / Chapter Appendix: 1.0. --- Variability of a Thoracic Paravertebral Block. Are we ignoring the endothoracic fascia? (Published Commentary) --- p.297 / Chapter Appendix: 2.0. --- Ipsilateral Thoraco-lumbar Anaesthesia and Paravertebral Spread after Low Thoracic Paravertebral Injection. (Published Case Report) --- p.301 / Chapter Appendix: 3.0. --- The Use of a Nerve Stimulator for Thoracic Paravertebral Block Reply. (Published Letter-to-editor) --- p.310 / Chapter Appendix: 4.0. --- Bilateral Continuous Paravertebral Block Used for Postoperative analgesia in an Infant having Bilateral Thoracotomy. (Published Case Report) --- p.312 / Chapter Appendix: 5.0. --- Thoracic Paravertebral Block: Radiological evidence of Contralateral Spread Anterior to the Vertebral Bodies. (Published Case Report) --- p.317 / Chapter Appendix: 6.0. --- Lymphatic Drainage of the Thoracic Paravertebral Space A Reply. (Published Letter-to-editor) --- p.325 / Chapter Appendix: 7.0. --- Thoracic Paravertebral Block for Management of Pain Associated with Multiple Fractured Ribs in Patients with Concomitant lumbar Spinal Trauma. (Published Case Report) --- p.328 / Chapter Appendix: 8.0. --- Right Thoracic Paravertebral Analgesia for Hepatectomy. (Published Case Report) --- p.340 / Chapter Appendix: 9.0. --- Resolution of ST-segment Depression after High Thoracic Paravertebral Block during General Anesthesia. (Published Case Report) --- p.348 / Chapter B. --- Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36) - Appendix 10. --- p.353 / Chapter C. --- Hospital Anxiety and Depression Scale - Appendix 11. --- p.362 / Chapter D. --- Postoperative Telephone Follow Up Questionnaire: Appendix 12. --- p.364

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the hamstring donor site, prompting some clinicians to employ continuous sciatic peripheral nerve blockade via an indwelling catheter. A lack of comparative effectiveness studies exists in the literature regarding the duration of action of peripheral nerve blockade necessary to adequately provide pain control following hamstring autograft harvest, resulting in disagreement among clinicians as to best pain control practices. Proponents of continuous sciatic peripheral nerve blockade assert that while more costly, the extended duration of analgesia afforded by this technique improves pain control postoperatively and decreases the use of other pain medications. Advocates of single-injection sciatic peripheral nerve blockade cite concerns associated with continuous sciatic peripheral nerve blockade known to be detrimental to rehabilitation, such as decreased active knee flexion and increased risk of falls. The purpose of this research is to compare the effect of single-injection sciatic PNB to continuous sciatic PNB on 1) postoperative pain control as measured by self-reported pain scores, pain medication use, and unplanned hospital admission due to poor pain control, 2) active knee flexion, and 3) patient satisfaction with pain control following ACL reconstruction with a hamstring autograft. The findings of this study have the potential to guide informed clinical reasoning and decision making regarding sciatic peripheral nerve blockade techniques following hamstring autograft harvest in adolescents undergoing anterior cruciate ligament reconstruction.