Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 0.5% articaine and 0.5% prilocaine in intravenous regional anesthesia of the arm: a cross-over study in volunteers.
Earlier studies of the use of articaine in intravenous regional anesthesia (IVRA) are conflicting. In fact, despite similar physicochemical properties and regional anesthetic action, significant differences between articaine and prilocaine in IVRA have been reported. Articaine, being a potent local anesthetic with low degree of toxicity and being rapidly metabolized by esterases, could be a useful local anesthetic particularly in IVRA and, perhaps, could challenge prilocaine, the present local anesthetic of choice for this technique. ⋯ Both 0.5% articaine and 0.5% prilocaine, in a median dose of 40 mL in adults, injected in 2 minutes, are effective and equipotent local anesthetics in IVRA of the arm. An earlier reported four-time faster onset time of the block by articaine in comparison with prilocaine may be caused by a very rapid injection rate (40 mL/30 sec) by the investigators of that study. The erythematous skin rashes after IVRA, in particular when articaine was used, may be a sign of venous endothelial irritation.
-
Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Clinical TrialEvaluation of peripheral morphine analgesia for lumpectomy and axillary node dissection: a randomized, double-blind, placebo-controlled study.
Morphine may elicit potent antinociceptive effects by binding and activating peripheral opioid receptors. However, the results in clinical studies have varied. We examined the postoperative analgesic effects of incisional morphine in patients undergoing lumpectomies and axillary node dissections for breast cancer. For this purpose, a concentration of morphine within the range (0.25-0.6%) of those utilized in previous studies for postarthroscopy analgesia was chosen (0.6%). ⋯ These results suggest that under the conditions of the study protocol, there is no value in utilizing morphine in solution at the surgical site for postoperative lumpectomy and axillary node dissection analgesia.
-
Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Clinical TrialThe association between injected volume of local anesthetic and spread of epidural anesthesia: a hypothesis.
Clinically, an increase of the injected volume of local anesthetic does not result in a linear increase in the spread of epidural anesthesia. This study was designed to evaluate this observation. ⋯ The present study demonstrates lack of a linear relationship between injected volume of local anesthetic and spread of epidural anesthesia. Whether the cubic equation developed is clinically useful remains unclear because of the variability of the data.
-
Reg Anesth Pain Med · Mar 1999
Case ReportsAnxiety, vocalization, and agitation following peripheral nerve block with ropivacaine.
Central nervous system (CNS) and cardiovascular toxicity are potential side effects of local anesthetics. However, ropivacaine has been reported to be less CNS toxic than bupivacaine in human volunteers. ⋯ This case report shows that ropivacaine may cause CNS toxicity that differs from classical signs of local anesthetic-induced toxicity. This effect might be related to the unique structure of ropivacaine, which is formulated in an S-enantiomer preparation. It has been shown that S-enantiomers bind differently to receptors in both the CNS and cardiovascular systems. This property may account for the disinhibition of select neural pathways that are specifically involved in mediation of anxiety and aggression.