Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 1998
Randomized Controlled Trial Clinical TrialAddition of bupivacaine to sufentanil in patient-controlled epidural analgesia after lower limb surgery in young adults: effect on analgesia and micturition.
The usefulness of adding bupivacaine to an opioid administered by the epidural route is controversial. This study examines both the quality of pain relief and side effects, in particular urinary retention, during patient-controlled epidural analgesia (PCEA) with sufentanil alone or in combination with two different concentrations of bupivacaine. ⋯ A 0.06% bupivacaine-sufentanil combination offered the best results in terms of analgesic quality and lower side effects, mainly micturition problems, which may be explained by the higher consumption of local anesthetic at the higher bupivacaine concentration. Analgesic quality could not be improved by increasing the bupivacaine concentration.
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Reg Anesth Pain Med · Mar 1998
Clinical TrialHigh-dose ropivacaine wound infiltration for pain relief after inguinal hernia repair: a clinical and pharmacokinetic evaluation.
Early data on ropivacaine, a recently introduced local anesthetic, indicate a longer duration of skin analgesia than with bupivacaine, along with lower toxicity. The objective of this study was to evaluate ropivacaine 7.5 mg/mL for wound infiltration pain relief after hernia surgery, in higher doses than used before, in an open, nonrandomized design. ⋯ Infiltration of ropivacaine 7.5 mg/mL during hernia surgery can be employed safely in doses of 300 mg and 375 mg to control pain after hernia surgery. The lower dose is recommended, since the higher one did not give any clinically relevant advantages.
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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 · Mar 1998
Randomized Controlled Trial Clinical TrialThe peripheral analgesic effect of meperidine in reducing propofol injection pain is not naloxone-reversible.
Meperidine is frequently used in general anesthesia and perioperative analgesia. In addition to its opioid action, meperidine possesses some local anesthetic properties. A preliminary study using the tourniquet venous retention technique found meperidine to be more effective in reducing propofol injection pain than fentanyl or morphine, both of which were slightly better than placebo. This study was undertaken to evaluate whether this peripheral analgesic effect of meperidine is affected by naloxone. ⋯ The peripheral analgesic effect of meperidine in reducing propofol injection pain is not mediated by its opioid activity.
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Reg Anesth Pain Med · Mar 1998
Clinical Trial Controlled Clinical TrialSpinal anesthesia with tetracaine in 0.75% glucose: influence of the vertebral interspace used for injection.
The anesthetic behavior and hemodynamic consequences of spinal anesthesia with marginally hyperbaric tetracaine containing a low concentration of glucose injected at two different interspaces were examined and compared with those of conventionally hyperbaric solution. ⋯ A marginally hyperbaric tetracaine solution injected at the L2-L3 interspace with the patient in the lateral position produced greater extent of cephalad spread than that at the L3-L4 interspace. When compared to a conventionally hyperbaric tetracaine solution injected at the L3-L4 interspace, the marginally hyperbaric solution injected at the L2-L3 interspace caused less hemodynamic variability despite similar levels of maximum sensory block.