British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace.
Spinal anaesthesia was compared in 40 obese patients (increased body mass index (BMI] and 40 patients with normal BMI when 3 ml of plain 0.5% bupivacaine was injected at either the L3-4 or L4-5 interspace. More extensive cephalad spread of sensory block was achieved in patients with increased BMI compared with patients with normal BMI after injection at both L3-4 and L4-5 (P less than 0.05). ⋯ Good anaesthesia was produced in all patients for orthopaedic surgery of the lower extremity. In an obese patient it is recommended that plain bupivacaine be administered at L4-5 instead of L3-4 when extensive spread of the block is to be avoided.
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A retrospective study of serious non-fatal complications of extradural block in obstetric practice was carried out using a postal questionnaire. Two hundred and three obstetric units in the United Kingdom (responsible for 2,580,000 deliveries from 1982 to 1986 inclusive) responded. A total of 505,000 extradural blocks were performed, 84% for relief of pain in labour and 16% for Caesarean section. ⋯ Neuropathy involving a single spinal nerve, acute toxicity from the local anaesthetic, and problems associated with accidental dural puncture were the commonest complications. This investigation indicates the need for a prospective study. Although rare, serious complications could be reduced further by meticulous technique, while early diagnosis and treatment of untoward events would reduce the incidence of permanent disability.
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A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. ⋯ In the patients undergoing oral surgery, ibuprofen administered before operation significantly reduced analgesic requirement, without unwanted side effects. The use of codeine-paracetamol or a non-steroidal anti-inflammatory agent before body surface surgery appeared to be advantageous in reducing postoperative analgesic needs, without causing problems associated with the stronger opioids.
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Randomized Controlled Trial Comparative Study Clinical Trial
Misplacement of subclavian venous catheters: importance of head position and choice of puncture site.
We have investigated the frequency of misplacement of subclavian catheters in 200 consecutive patients admitted to the Intensive Care Unit. The patients were allocated randomly to an attempt at infraclavicular cannulation of the right or left subclavian vein with the head turned either towards or away from the selected side, giving four groups. ⋯ Misplacement into the internal jugular vein occurred in 10 (5.4%) patients. No statistically significant difference (P less than 0.05) was demonstrated between the four groups.