Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialSensory block extension during combined spinal and epidural.
During a combined spinal and epidural technique, extension of sensory block by epidural injection of saline or bupivacaine has been demonstrated and attributed to a volume effect or to the combination of a volume effect with a local anesthetic effect. This two-part study was designed to evaluate the time dependency of the volume effect and the local anesthetic effect on the mechanism of spinal block extension. ⋯ During a combined spinal and epidural technique with the use of hyperbaric bupivacaine, the volume effect is time dependent and is seen when epidural top up is done soon after spinal injection. This volume effect is abolished when patients are left seated for 5 minutes after spinal injection. The local anesthetic effect is not demonstrated when high sensory block levels are achieved by spinal injection.
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Reg Anesth Pain Med · Jan 1998
Randomized Controlled Trial Clinical TrialEnhancement of analgesic effect of intrathecal neostigmine and clonidine on bupivacaine spinal anesthesia.
Intrathecal administration of neostigmine has been shown to produce analgesia in both animals and humans. The concurrent administration of intrathecal neostigmine and clonidine has been reported to produce no neurotoxicity in sheep. The purpose of the present study was to evaluate the efficacy and safety of the combining intrathecal neostigmine and clonidine for the relief of pain in patients after cesarean delivery. ⋯ Our study showed that the combination of 150 microg i.t. clonidine and 50 microg neostigmine provided longer postsurgical analgesia than with either drug used alone. However, this combination also produced significantly more adverse effects of prolonged motor block and nausea and vomiting. A further study combining the two study drugs but using a lower dose of i.t. neostigmine (e.g., 25 microg) is recommended.
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Reg Anesth Pain Med · Jan 1998
Case ReportsParaplegia following intracord injection during attempted epidural anesthesia under general anesthesia.
A case of permanent paraplegia is reported following attempted epidural anesthesia for a total knee replacement in a 62-year-old woman with a history of lumbar laminectomy for a prolapsed intervertebral disc. ⋯ Standards of management are discussed in relation to this case.
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Reg Anesth Pain Med · Jan 1998
Intrathecal addition of morphine to bupivacaine is not the cause of postoperative nausea and vomiting.
Postoperative nausea and vomiting after anesthesia is an distressing side effect. This study was undertaken to determine to what extent spinal opioids contribute to postoperative nausea and vomiting (PONV) and secondly to how effectively metoclopramide can reduce the incidence of PONV after intrathecal administration of morphine. ⋯ Administration of metoclopramide did not reduce the overall incidence of PONV. Our study shows no relationship between the use of intrathecal morphine and the incidence of PONV during the first 24 hours postoperative.