Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Multicenter Study
Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial.
The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. ⋯ Our results were largely consistent with previous much smaller studies. Compared with sevoflurane GA with opioid analgesia, the combination of paravertebral analgesia with propofol GA provides an early clinical analgesic benefit in females having breast cancer surgery. This analysis is a substudy of an ongoing multicentre double-blinded randomized trial ( www.clinicaltrials.gov , NCT00418457) of cancer recurrence.
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Observational Study
Transient Horner's syndrome following thoracic epidural anesthesia for mastectomy: a prospective observational study.
Transient Horner's syndrome is an uncommon complication of epidural anesthesia, though its exact incidence in thoracic epidural anesthesia is not clear. Therefore, this study prospectively evaluated the incidence of Horner's syndrome after thoracic epidural anesthesia for mastectomy. ⋯ The incidence of Horner's syndrome following thoracic epidural anesthesia and continuous thoracic epidural analgesia for mastectomy was 1.4%. The mechanism was consistent with cephalic spread of the epidural local anesthetic. This trial was registered at: Clinicaltrials.gov, number: NCT02130739.
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Obstetricians and anesthesiologists may interpret medical evidence differently, which could potentially generate conflict and compromise patient care. We sought to identify the most important controversial topics involving obstetricians and anesthesiologists on the labour ward that had the potential to affect patient outcome. ⋯ Both the obstetricians and the anesthesiologists identified several controversial topics that may influence clinical practice on the labour ward. This information could serve as the basis to develop educational programs and strategies to improve communication between the two disciplines.
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The purpose of this study was to investigate the ability of the electrical epidural stimulation test (EST) to determine the position of the epidural catheter during combined spinal-epidural (CSE) anesthesia for labour analgesia. ⋯ The intrathecal injection of a low dose of bupivacaine-fentanyl does not affect the MTC if the catheter is placed in the epidural space; however, it does affect the threshold if the catheter is placed intrathecally. We also confirm that the EST can help to determine the position of the epidural catheter prior to injection of the test dose. This trial was registered at ClinicalTrials.gov (NCT00464841).