Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of continuous epidural infusion and intermittent intravenous bolus doses of morphine in children undergoing selective dorsal rhizotomy.
Selective dorsal rhizotomy (SDR) is associated with moderale to severe postoperative pain. Although the efficacy of epidural analgesia in this population has been demonstrated, it has not been compared with conventional intravenous (i.v.) analgesia. This prospective study compared the effects of epidural and i.v. morphine regarding postoperative analgesia, side effects, and outcomes in children following SDR. ⋯ Both techniques provided effective postoperative analgesia with a similar incidence of side effects; however, our findings suggest that continuous infusions of epidural morphine improved overall comfort with lower pain scores, fewer muscle spasms, and improved tolerance of activity during the initial postoperative period.
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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 · Sep 1999
Comparative StudyEffects of levobupivacaine, bupivacaine, and ropivacaine on tail-flick response and motor function in rats following epidural or intrathecal administration.
Commercially available bupivacaine is a racemic mixture of S (-)- and R(+)-enantiomers. Although the S(-)-enantiomers levobupivacaine and ropivacaine are less toxic to the cardiovascular and central nervous systems than bupivacaine, their relative efficacy has not been determined. This study directly compares the dose response of levobupivacaine, ropivacaine, and bupivacaine following epidural and intrathecal administration in the rat. ⋯ Levobupivacaine, given epidurally or intrathecally, produces longer lasting antinociceptive action than ropivacaine at equivalent concentrations and similar motor blocking effect at lower concentrations in both epidural and intrathecal administrations. Levobupivacaine-induced prolongation of the tail-flick latency is comparable to that of bupivacaine, as is motor blocking effect at higher concentrations. The possibility of significant differential block with levobupivacaine compared with bupivacaine warrants further study.
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Reg Anesth Pain Med · Sep 1999
Comment Letter Case ReportsAn entrapped epidural catheter in a postpartum patient.