Anaesthesia
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Observations were made during the use of a Tuohy needle to perform deliberate dural puncture for the insertion of lumbar drains to improve operating conditions for intracranial aneurysm surgery. The most striking finding was the distance from identification of the epidural space to penetration of the dura. ⋯ This minimised the reactive forces across the dura. Aspiration and rotation of the Tuohy needle revealed dural puncture in some cases.
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Randomized Controlled Trial Clinical Trial
Continuous thoracic epidural fentanyl for post-thoracotomy pain relief: with or without bupivacaine?
Twenty-five ASA 1 or 2 patients undergoing thoracotomy were entered into a prospective, randomised, double-blind study comparing thoracic epidural fentanyl alone and thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief, pulmonary function and cardiovascular stability were assessed. ⋯ The incidence of side effects attributable to epidural fentanyl was high, but hypotension did not occur. Small doses of bupivacaine administered together with fentanyl into the thoracic epidural space improve analgesia without causing hypotension.