Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2000
Comment Letter Clinical TrialTreatment of pain from vertebral compression fractures caused by osteoporosis.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans.
Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome. ⋯ A low-dose epidural infusion of epinephrine decreased anesthetic requirements.
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Reg Anesth Pain Med · May 2000
Comparative Study Clinical Trial Controlled Clinical TrialLow-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.
The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension. ⋯ Bupivacaine 5 mg + fentanyl 25 microg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.
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Reg Anesth Pain Med · May 2000
Case ReportsLateral cervical epidural catheter placement for continuous unilateral upper extremity analgesia and sympathetic block.
The use of the laterally directed cervical epidural catheter for the treatment of acute and chronic pain has not been previously described. We have used this technique in a series of 30 patients to produce unilateral upper extremity analgesia and sympathetic block. We present a case report of a patient treated with this technique and a description of the technique and results from the series. ⋯ This case report shows results typical of this series of 30 patients. In this series, the laterally directed cervical epidural catheter was an effective technique to produce continuous unilateral analgesia and sympathetic block. Key Words: Analgesia (epidural), Autonomic nerve block, Reflex sympathetic dystrophy, Postoperative pain.
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Reg Anesth Pain Med · May 2000
Case ReportsDetermining epidural catheter location using nerve stimulation with radiological confirmation.
The use of epidural stimulation to confirm epidural catheter placement has been shown. This case report describes the benefits and problems of using the epidural stimulation test to confirm epidural catheter placement and provides supporting evidence for these observations using radiological imaging. ⋯ This report illustrates some of the potential benefits and problems of using the nerve stimulation test to confirm epidural catheter placement, with radiological verification.