Regional anesthesia and pain medicine
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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.
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Reg Anesth Pain Med · Mar 1999
Multicenter Study Comparative Study Clinical Trial Controlled Clinical TrialRopivacaine 0.25% and 0.5%, but not 0.125%, provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels.
Ropivacaine is a long-acting local anesthetic similar to bupivacaine, but with lower cardiac toxicity and intrinsic vasoconstrictive properties that may reduce the risk and extent of systemic plasma absorption. Plasma levels and risks are associated with the total dose used and the extent of absorption, with lower doses potentially representing less risk. Although both 0.5% and 0.75% ropivacaine provide adequate analgesia for wound infiltration after hernia repair, the efficacy of lower doses and the early systemic absorption have not been reported. ⋯ Ropivacaine 0.25% and 0.5% is adequate for pain relief after outpatient hernia repair, whereas the 0.125% solution is no more effective than saline. Prolonged systemic absorption from peripheral injection may be associated with prolonged elevations of plasma concentrations, which potentially could be associated with unexpectedly high plasma levels if repeated injections are performed in the perioperative period with higher concentrations or doses.
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Reg Anesth Pain Med · Jan 1999
Multicenter Study Clinical TrialThe PENCAN 25-gauge needle: a new pencil-point needle for spinal anesthesia tested in 1,193 patients.
The PENCAN 25-gauge spinal needle is a new pencil-point needle with an inner diameter of 0.32 mm resulting in a relatively high cerebrospinal fluid (CSF) flow. The PENCAN 25-gauge needle was tested for ease of identification of a successful dural puncture, the failure rate of spinal anesthesia, and the incidence of postdural puncture headache (PDPH). ⋯ A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible "click" made prompt recognition of successful dural puncture possible.
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Reg Anesth Pain Med · Nov 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparative evaluation of four different infusion rates of ropivacaine (2 mg/mL) for epidural labor analgesia.
Previous studies have reported comparable efficacy for ropivacaine and bupivacaine when used for labor analgesia at concentrations of 2.5 mg/mL. In this multicenter study, we assessed ropivacaine at the commercially available concentration of 2 mg/mL (0.2%) for labor pain management. ⋯ The 2 mg/mL of ropivacaine produces satisfactory labor analgesia at epidural infusion rates of 4, 6, 8, and 10 mL/hour, provided supplemental bolus dosages are available. Clinically, a rate of 6 mL/hour may be the lowest effective rate that provides the best combination of pain relief, motor block, and rebolusing, although rates of 8 and 10 mL/hour produced similar results.