Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2000
Comment Letter Clinical TrialTreatment of pain from vertebral compression fractures caused by osteoporosis.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialProcaine compared with lidocaine for incidence of transient neurologic symptoms.
Transient neurologic symptoms (TNS) have been reported to occur after 16% to 40% of ambulatory lidocaine spinal anesthetics. Patient discomfort and the possibility of underlying lidocaine neurotoxicity have prompted a search for alternative local anesthetic agents. We compared the incidence of TNS with procaine or lidocaine spinal anesthesia in a 2:1 dose ratio. ⋯ The incidence of TNS was substantially lower with procaine than with lidocaine. However, procaine resulted in a lower overall quality of anesthesia and a prolonged average discharge time. If the shortfalls of procaine as studied can be overcome, it may provide a suitable alternative to lidocaine for outpatient spinal anesthesia to minimize the risk of TNS.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialZiconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain.
Voltage-sensitive calcium channel conductance is essential for the nervous system to signal a painful event. However, intrathecal administration of L-type calcium channel blockers does not provide analgesia. The present investigation was designed to assess the safety and analgesic efficacy of ziconotide, a new N-type calcium channel blocker, when administered intrathecally to patients with acute postoperative pain. ⋯ Ziconotide showed analgesic activity, as shown by decreased PCA morphine equivalent consumption and lower VASPI scores. Because of a favorable trend of decreased morphine consumption with an acceptable side-effect profile in the low-dose ziconotide group, 0.7 microg/h may be closer to the ideal dose than 7 microg/h. Large-scale studies are required to clarify this issue.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans.
Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome. ⋯ A low-dose epidural infusion of epinephrine decreased anesthetic requirements.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture.
Combined spinal epidural anesthesia (CSEA) involves the epidural administration of local anesthetic and opioid solutions adjacent to the prior dural puncture, potentially increasing their diffusion into the subarachnoid space. This study was designed to evaluate the influence of dural puncture on the adequacy and extent of analgesia, and drugs requirements of patient-controlled epidural analgesia (PCEA) in the postoperative period. ⋯ Dural puncture with a 25-gauge Quincke needle, performed as part of CSEA, does not influence the drug requirements when a combination of 0.1% bupivacaine and fentanyl (3 microg/mL) is used for PCEA after major abdominal surgery.