Canadian journal of anaesthesia = Journal canadien d'anesthésie
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A patient is presented whose lumbar epidural catheter was found to lie in the paravertebral tissues during a right radical nephrectomy. The catheter had been placed with the patient awake and the procedure performed in a routine fashion without difficulty or indication of catheter malposition. Four ml of 2% CO2 lidocaine were initially injected as a test dose without any demonstrable effect. ⋯ Previous studies suggest that transforaminal escape of an epidural catheter occurs after 1-6% of insertions. It may occur without nerve root symptoms during catheter placement. The authors recommend that epidural catheters be introduced whilst the patients are awake and an effective block demonstrated before induction of general anaesthesia.
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Randomized Controlled Trial Clinical Trial
Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia.
In this prospective study, the postoperative analgesic effects of intraoperative iv clonidine were evaluated. Two hundred consecutive patients undergoing major abdominal surgery were randomly assigned to either balanced anaesthesia with iv clonidine (Group 1) or balanced anaesthesia alone (Group 2). A PCA infuser was connected immediately after tracheal extubation. ⋯ Clonidine did not exacerbate sedation or side effects. However, clonidine provided better analgesia in men and in patients less than 65 yr of age. Intraoperative iv clonidine enhances morphine analgesia after abdominal surgery.
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Letter Randomized Controlled Trial Clinical Trial
Spinal catheter does not reduce post-dural puncture headache after caesarean section.