Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialEfficacy of simulated epinephrine-containing epidural test dose after intravenous atropine during isoflurane anesthesia in children.
A double-blind, randomized study was performed to investigate heart rate (HR) and blood pressure responses to 2 doses of intravenous (IV) epinephrine (0.5 and 0.75 microg/kg) in 61 children, ages 3 months to 12 years. ⋯ A simulated epidural test dose containing lidocaine 1 mg/kg with epinephrine 0.75 microg/kg, administered IV following atropine, may reliably increase HR to indicate unintentional injection into epidural vessels of children anesthetized with 1 MAC isoflurane.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialComparison of three catheter sets for continuous spinal anesthesia in patients undergoing total hip or knee arthroplasty.
Continuous spinal anesthesia (CSA) with microcatheters may be complicated because of technical problems. In elderly patients, some of the problems may be solved by using thicker catheters. A recent invention, involving a catheter-over-needle system, may prevent leakage of cerebrospinal fluid (CSF) and may also improve the prediction of the intrathecal position of the catheter tip. ⋯ Placement of the SC catheters was unsuccessful to a high degree, and bone contact produced distortion of the tip of some of these catheters. Otherwise, the quality associated with catheterization time, anesthetic distribution, and catheter function was similar with the 3 catheters.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffects of epidural injection on spinal block during combined spinal and epidural anesthesia for cesarean delivery.
Epidural injection has been known to enhance spinal anesthesia in combined spinal and epidural (CSE) anesthesia. Saline and local anesthetics have been reported to have a volume effect, elevating sensory level when supplementing a volume into the epidural space. We evaluated the effects of epidural injection when using the CSE technique for cesarean delivery. ⋯ We could not achieve satisfactory surgical analgesia with 8 mg of hyperbaric bupivacaine injected into the subarachnoid space using the needle-through-needle technique in cesarean deliveries. An epidural saline injection elevated the sensory level, which did not improve the spinal block, whereas an epidural injection of 10 mL of 0.25% bupivacaine enhanced the spinal block and sustained the block postoperatively.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialPain on intramuscular injection of bupivacaine, ropivacaine, with and without dexamethasone.
We wished to determine which long-acting local anesthetic would produce the least pain on injection for treatment of myofascial pain disorders. We compared the pain on intramuscular injection of bupivacaine, ropivacaine, bupivacaine with dexamethasone, ropivacaine with dexamethasone, and needle placement alone. ⋯ The pain on intramuscular injection of bupivacaine is significantly more intense than with ropivacaine. The difference in the intensity of the pain on injection between bupivacaine and ropivacaine does not appear to be related to differences in pH. The results of our study have implications on the choice of the local anesthetic used in trigger point injections.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialA low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia.
Unilateral spinal anesthesia may be advantageous, especially in the outpatient setting. A low dose of anesthetic solution, pencil-point needle, low speed of intrathecal injection, and a lateral position have been reported to facilitate the production of unilateral distribution of spinal anesthesia. We compared the effects of plain and hyperbaric bupivacaine in attempting to obtain a unilateral spinal anesthesia for patients undergoing outpatient knee arthroscopy. ⋯ In conclusion, the spinal anesthesia in both groups are suitable alternatives for adult outpatient knee arthroscopies, but hyperbaric bupivacaine provides us with a more unilateral spinal block.