Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2000
Clinical Trial Controlled Clinical TrialRespiratory gas exchange and hemodynamics during lumbar epidural anesthesia: effects of lidocaine with and without epinephrine.
Epinephrine modifies the hemodynamic response to epidural local anesthetic; effects on respiratory gas exchange are not known. We hypothesized that epidural epinephrine would increase oxygen consumption and carbon dioxide production. ⋯ The addition of epinephrine, 5 microg x mL(-1), to the epidural injection of 2% lidocaine is associated with changes not only in hemodynamics, but also in respiratory gas exchange.
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Reg Anesth Pain Med · Jul 2000
Comparative StudyAn in vitro study of dural lesions produced by 25-gauge Quincke and Whitacre needles evaluated by scanning electron microscopy.
A study using scanning electron microscopy showed that although the laminas forming the dura mater are concentric and parallel to the surface of the medulla, the fiber layers' orientations are different in each sub-lamina, dispelling the conventional knowledge that all the fibers of the dura are arranged in a parallel direction. Thus, this study evaluated the dural lesions produced by Whitacre and Quincke spinal needles in the external and internal surface of the dura mater of the lower spine area in an attempt to gain more insight into the pathophysiology of postdural puncture headaches (PDPH). ⋯ The needles produced lesions in the dura with different morphology and characteristics. Lesions with the Quincke needles resulted in a clean-cut opening in the dural membrane while the Whitacre needle produced a more traumatic opening with tearing and severe disruption of the collagen fibers. Thus, we hypothesized that the lower incidence of PDPH seen with the Whitacre needles may be explained, in part, by the inflammatory reaction produced by the tearing of the collagen fibers after dural penetration. This inflammatory reaction may result in a significant edema which may act as a plug limiting the leakage of cerebrospinal fluid.
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Reg Anesth Pain Med · Jul 2000
Clinical Trial Controlled Clinical TrialEMLA reduces acute and chronic pain after breast surgery for cancer.
A significant percentage of women undergoing breast surgery for cancer may develop neuropathic pain in the chest, and/or ipsilateral axilla and/or upper medial arm, with impairment in performing daily occupational activities. We designed this study to determine if the perioperative application of EMLA (eutectic mixture of local anesthetics; AstraZeneca) cream in the breast and axilla area reduces analgesic requirements, as well as the acute and chronic pain after breast surgery. ⋯ The application of EMLA to patients undergoing breast surgery for cancer reduced the postoperative analgesic requirements and the incidence and intensity of chronic pain.