Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialOver-the-needle versus microcatheter-through-needle technique for continuous spinal anesthesia: a preliminary study.
A new catheter-over-needle design (Spinocath, B. Braun) has been developed to minimize problems and complications of continuous spinal anesthesia with microcatheters, which include difficult catheter insertion, failure of insertion, breakage, inadequate anesthesia, postdural puncture headache, and, rarely, development of cauda equina syndrome. ⋯ Insertion, maintenance, and clinical effects were better achieved with the catheter-over-the needle design compared to the microcatheter. These preliminary findings need to be confirmed by a larger study.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialUse of clonidine in hernia patients: intramuscular versus surgical site.
This study was designed to determine if administration of clonidine in hernia patients enhances analgesia. It was also designed to determine whether administration directly in the surgical site further improves the analgesia. ⋯ When clonidine is administered to patients undergoing hernia repair, the 2-hour pain scores are lowered. No difference was exhibited when clonidine was administered intramuscularly or directly into the hernia site.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Comparative Study Clinical TrialInfraclavicular brachial plexus block: variation in approach and results in 360 cases.
Brachial plexus block is clinically useful. Although the infraclavicular approach to brachial block is the less commonly used form it may offer advantages. We describe the results with three local anesthetic mixtures used during this observational study. ⋯ The infraclavicular approach described is effective. It produced reliable anesthesia and is associated with minimal complications and side effects. The mixture of local anesthetics used in group II is not adequate for producing reliable anesthesia.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialEfficacy of simulated intravenous test dose in the elderly during general anesthesia.
Reliability of detecting unintentional intravascular injection of the epinephrine-containing test dose is improved by decreasing the heart rate (HR) threshold to 10 beats/min during combined epidural and general anesthesia. We have tested whether this modified HR criterion is still applicable in the anesthetized elderly patients. ⋯ Our results indicate that the efficacy of the modified HR criterion using epinephrine-containing test dose is clinically applicable in most elderly patients, and the combination of the SBP and the modified HR criteria is reliable in detecting intravascular injection during combined epidural and general anesthesia.
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Reg Anesth Pain Med · Jul 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialRemifentanil versus alfentanil as analgesic adjuncts during placement of ophthalmologic nerve blocks.
Short-acting opioids are often used prior to the placement of ophthalmologic nerve blocks. This study examines whether remifentanil would provide superior analgesia compared with alfentanil, without oversedation or prolonged recovery when given either as a single dose over 30 seconds or as a single dose followed by a continuous infusion, in a dose ratio of 1:7 (remifentanil:alfentanil). ⋯ Remifentanil 1 microg/kg results in superior analgesia compared with alfentanil 7 microg/kg when used during the placement of ophthalmologic nerve blocks. The combination of a single dose of remifentanil followed by a continuous infusion was equally effective but resulted in a higher incidence of respiratory depression.