Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 1998
Randomized Controlled Trial Comparative Study Clinical TrialA comparative study of low-dose hyperbaric spinal lidocaine 0.5% versus 5% for continuous spinal anesthesia.
Concerns of cauda equina syndrome have discouraged clinicians to use 5% lidocaine for continuous spinal anesthesia. Earlier reports indicated that single-shot spinal lidocaine 0.5% is effective for minor gynecologic and perianal surgery. In the present study, we evaluate the anesthetic and hemodynamic effects of low dose hyperbaric 0.5% lidocaine for continuous spinal anesthesia and compare with those of the 5% lidocaine solution in patients undergoing urologic surgery. ⋯ Continuous spinal anesthesia produced by 0.5% lidocaine with 7.5% dextrose is as effective as that produced by the 5% lidocaine solution in elderly patients undergoing urologic surgery. An initial 30-mg bolus delivered via indwelling subarachnoid catheter was sufficient to achieve surgical anesthesia for approximately 50 minutes in most patients. Hemodynamic effects of the two lidocaine solutions were also comparable.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialIncisional morphine has no analgesic effect on postoperative pain following inguinal herniotomy.
Opioids induce antinociceptive effects after peripheral administration in experimental and clinical studies. The results of the clinical studies are conflicting. The objective of this study was to examine a possible analgesic effect of incisionally administered morphine on postoperative pain in patients undergoing inguinal herniotomy during general anesthesia. ⋯ The analgesic effect of a single 5 mg dose of morphine injected in a herniotomy wound is not superior to saline or to morphine given subcutaneously or intravenously.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialSensory block extension during combined spinal and epidural.
During a combined spinal and epidural technique, extension of sensory block by epidural injection of saline or bupivacaine has been demonstrated and attributed to a volume effect or to the combination of a volume effect with a local anesthetic effect. This two-part study was designed to evaluate the time dependency of the volume effect and the local anesthetic effect on the mechanism of spinal block extension. ⋯ During a combined spinal and epidural technique with the use of hyperbaric bupivacaine, the volume effect is time dependent and is seen when epidural top up is done soon after spinal injection. This volume effect is abolished when patients are left seated for 5 minutes after spinal injection. The local anesthetic effect is not demonstrated when high sensory block levels are achieved by spinal injection.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialEnhancement of analgesic effect of intrathecal neostigmine and clonidine on bupivacaine spinal anesthesia.
Intrathecal administration of neostigmine has been shown to produce analgesia in both animals and humans. The concurrent administration of intrathecal neostigmine and clonidine has been reported to produce no neurotoxicity in sheep. The purpose of the present study was to evaluate the efficacy and safety of the combining intrathecal neostigmine and clonidine for the relief of pain in patients after cesarean delivery. ⋯ Our study showed that the combination of 150 microg i.t. clonidine and 50 microg neostigmine provided longer postsurgical analgesia than with either drug used alone. However, this combination also produced significantly more adverse effects of prolonged motor block and nausea and vomiting. A further study combining the two study drugs but using a lower dose of i.t. neostigmine (e.g., 25 microg) is recommended.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialSphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders.
This study examined the effectiveness of sphenopalatine ganglion block (SPGB) for myofascial pain syndrome of the head, neck, and shoulders using a double-blind, placebo-controlled, crossover study design with comparison to an internal standard consisting of trigger point injections (TPI). ⋯ This study suggests that SPGB with 4% lidocaine is no more efficacious than placebo and less efficacious than administration of standard trigger point injections in the treatment of myofascial pain of the head, neck, and shoulders.