Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 1998
Randomized Controlled Trial Clinical TrialThe recovery profile of hyperbaric spinal anesthesia with lidocaine, tetracaine, and bupivacaine.
Surgical procedures previously considered too lengthy for the ambulatory surgery setting are now being performed during spinal anesthesia. The complete recovery profile of tetracaine and bupivacaine are now of interest but are not available in the literature. This study was conducted to compare times to ambulation, voiding, and complete block resolution, as well as the incidence of back and radicular pain, after spinal anesthesia with lidocaine, bupivacaine, and tetracaine. ⋯ Among individual subjects, lidocaine exhibited the shortest recovery profile. However, the recovery profiles of the three anesthetics were very variable between subjects. Time to meeting discharge criteria after bupivacaine or tetracaine was faster in a few subjects than that after lidocaine in other subjects. For ambulatory anesthesia, times to two- and four-segment regression do not accurately predict time to readiness for discharge after spinal anesthesia.
-
Reg Anesth Pain Med · Mar 1998
Case ReportsPerisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome.
Piriformis syndrome causing sciatica is sometimes refractory to conventional treatments including physical therapy, piriformis injections, and even caudal epidural steroid injections. Surgical release of the piriformis muscle has been described for difficult cases of piriformis syndrome, but is occasionally accompanied by morbidity. Another approach to treating piriformis syndrome is presented. ⋯ Patients with piriformis syndrome who were refractory to conventional treatments but responded to perisciatic injections of steroid are presented.
-
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.
-
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.
-
Reg Anesth Pain Med · Mar 1998
Case ReportsAsymptomatic profound oxyhemoglobin desaturation following interscalene block in a geriatric patient.
Interscalene block can be chosen for complete anesthesia for shoulder surgery. Phrenic nerve block occurs with almost all interscalene blocks, but is well tolerated in most patients. This may not be the case in selected geriatric patients. ⋯ Ipsilateral phrenic nerve paralysis caused significant respiratory compromise in an elderly patient without known significant pulmonary disease.