Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 1999
The safety and efficacy of combined spinal and epidural analgesia/anesthesia (6,002 blocks) in a community hospital.
This study examined the safety and efficacy of combined spinal and epidural (CSE) analgesia/anesthesia performed in a community hospital. ⋯ This review of 6,002 CSE blocks performed in a community hospital has demonstrated that CSE labor analgesia, surgical anesthesia are safe and efficacious. We believe that patient observation and continuous pulse oximetry for 1-2 hours after administration of ITS and prompt treatment with intravenous naloxone for severe drowsiness, low oxygen saturation (PaO2 < 90% unresponsive to mask oxygen), or dysphagia should be used to minimize the risk of apnea.
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Reg Anesth Pain Med · Mar 1999
An investigation of the neurophysiologic mechanisms of tourniquet-related pain: changes in spontaneous activity and receptive field size in spinal dorsal horn neurons.
Several theories have been proposed for the pain resulting from the nerve compression and ischemia associated with maintaining the inflation of a pneumatic tourniquet on an extremity. This investigation observes changes in the spontaneous activity and receptive field (RF) size of spinal dorsal horn neurons during tourniquet-related nerve compression and ischemia. ⋯ The results of this study indicate that nerve compression and ischemia results in block of input to LTM neurons having RFs distal to the tourniquet cuff and an increase in spontaneous activity and expansion of the RFs of NRs, especially those with RFs located proximal to the tourniquet. Increases in spontaneous firing activity and expansion of the RFs of nociresponsive dorsal horn neurons receiving input from primary afferent nociceptors proximal to the tourniquet may explain, in part, the neurophysiologic mechanism of tourniquet-related pain.