Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous regional analgesia using bupivacaine. A double blind comparison with lignocaine.
A double-blind comparison of bupivacaine and lignocaine for intravenous regional analgesia (Bier's block) was carried out in seventy-two patients presenting for upper limb surgery. Thirty-eight patients received lignocaine and thirty-four received bupivacaine. ⋯ The degree of both analgesia and muscle relaxation was significantly better in the bupivacaine group. Adverse effects were seen only in patients who had received lignocaine and these were unrelated to the tourniquet time.
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The authors have described a fatal complication which occurred after a cervical subarachnoid block with phenol in glycerine. As a result of this experience they advocate the use of a dose of phenol of not more than 2 ml, which is smaller than that sometimes recommended, and also emphasise most strongly the importance of careful positioning of the patient.
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Case Reports
Post-partum intracranial subdural haematoma. A possible complication of epidural analgesia.
A case is reported of bilateral chronic subdural haematomas in a 29-year-old woman 1 month after childbirth under attempted epidural analgesia. The possible link between leakage of cerebrospinal fluid through a hole in the lumbar theca and the later development of an intracranial chronic subdural haematoma is discussed, with a review of eleven previous reported cases.
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A case of hearing deficit following nitrous oxide anaesthesia is reported. The mechanism and time course of nitrous oxide-induced intratympanic pressure changes are described and contrasted with the effects of non-nitrous oxide anaesthesia. The rate of increase is about 10 mm H20/min. The possibility that nitrous oxide may cause displacement of tympanic membrane grafts both outwards and inwards, or disrupt the reconstructed middle ear conducting mechanism, is raised again.