Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 1998
Randomized Controlled Trial Clinical TrialIntrathecal sufentanil and epidural bupivacaine for labor analgesia: dose-response of individual agents and in combination.
Combinations of local anesthetics and opioids are frequently used during spinal and epidural analgesia for the relief of labor pain. This combination allows for a dose-sparing effect which may reduce potential side effects or toxicity. The precise nature of the interaction between opioids and local anesthetics in the clinical setting, i.e., additivity versus synergism, has not been established. This trial was designed to utilize a validated technique of analysis of drug interactions, isobolography, to investigate this interaction. ⋯ Markedly reduced doses of these drugs in combination can be used to provide adequate analgesia during labor compared with either single drug alone.
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Reg Anesth Pain Med · Sep 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of intravenous nalbuphine infusion versus naloxone in the prevention of epidural morphine-related side effects.
Epidural morphine is accepted as an efficient means of postoperative pain management. However, development of side effects such as nausea and vomiting and pruritus has been reported. This study compared the efficacy of intravenous infusions of nalbuphine or naloxone in the prevention of epidural morphine-related side effects. ⋯ We found that coadministration of either nalbuphine or naloxone with epidural morphine reduces the incidence of morphine-related side effects. However, unlike naloxone, nalbuphine did not attenuate the analgesic effect of epidural morphine.
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Reg Anesth Pain Med · Jul 1998
Randomized Controlled Trial Comparative Study Clinical TrialA clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia.
The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. ⋯ The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.
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Reg Anesth Pain Med · Jul 1998
Randomized Controlled Trial Clinical TrialDifferential effect on vasodilatation and pain after intradermal capsaicin in humans during decay of intravenous regional anesthesia with mepivacaine.
When given intracutaneously, capsaicin can cause burning pain by central propagation in thin afferents, as well as neurogenic vasodilatation, reflecting antidromic conduction in the same fibers. We wanted to test the hypothesis that an intravenous regional block (IVRA) inhibits these two phenomena to a similar degree. ⋯ Mepivacaine, given as an IVRA, had no effect on the post-IVRA sensory function of thin afferents but differentially decreased the spread of the capsaicin-induced flare.
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Reg Anesth Pain Med · Jul 1998
Randomized Controlled Trial Comparative Study Clinical TrialThermoregulatory effects of spinal and epidural anesthesia during cesarean delivery.
Hypothermia is likely to develop faster during spinal anesthesia than epidural anesthesia. A natural consequence of the rapid temperature decrease during spinal anesthesia is that the shivering threshold will be reached sooner and that more shivering will be required to prevent further hypothermia. We tested the hypotheses that the onset of hypothermia is more rapid and the onset and intensity of shivering earlier during spinal than epidural anesthesia. ⋯ We failed to confirm our hypothesis, but for an unexpected reason: Thermoregulation was impaired more by spinal anesthesia than epidural anesthesia. It seems likely that in our patients spinal anesthesia inhibited thermoregulatory control more than epidural anesthesia because it better blocked sensory input from the legs.