Regional anesthesia
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Regional anesthesia · Sep 1990
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of 0.5% bupivacaine and 0.75% ropivacaine administered epidurally in humans.
In an attempt to compare equipotent doses of epidurally administered bupivacaine and ropivacaine, 44 healthy patients, aged 18-70 years, undergoing lower extremity orthopedic procedures were studied in a randomized, double-blind manner. Twenty-one patients received a single epidural injection of 20 ml 0.5% bupivacaine at the L23 or L34 interspace and 23 patients received 20 ml 0.75% ropivacaine in a similar manner. Onset of and recovery from sensory anesthesia and motor block were recorded. ⋯ Maximum block height (median (range] was T4 (T2-T8) and T5 (T2-L1) for bupivacaine and ropivacaine, respectively, and maximum motor block scores were 4 (2-6) and 4 (0-6) using the modified Bromage scale. Times to maximum height of sensory block for bupivacaine and ropivacaine, respectively, were 28 +/- 12 and 28 +/- 13 minutes; times to onset of block to T12 were 6 +/- 4 and 9 +/- 10 minutes; times to onset of maximum motor block were 32 +/- 17 and 47 +/- 29 minutes; times to two-segment regression were 2.7 +/- 0.8 and 3.4 +/- 1.0 hours (p less than 0.05); times to regression to T12 level were 4.8 +/- 0.9 and 4.7 +/- 0.95 hours; times to total recovery of sensation were 6.5 +/- 0.9 and 6.6 +/- 1.0 hours, and times to recovery of motor function were 4.4 +/- 0.9 and 4.1 +/- 0.9 hours. In two instances (both with bupivacaine), anesthesia was judged clinically inadequate.
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Regional anesthesia · Sep 1990
Anesthesia for cesarean delivery in patients with herpes simplex virus type-2 infections.
Some concerns exist regarding the use of regional anesthesia for patients with active genital herpes simplex virus type-2 (HSV) infections undergoing cesarean delivery. Previous studies have reported the safe use of epidural anesthesia in these patients; there are no reports of the use of spinal anesthesia in this setting. We performed a 6-year retrospective survey of 169 patients delivered by cesarean delivery because of HSV infection. ⋯ One patient who was diagnosed with primary herpes and who received spinal anesthesia had a transient postpartum neurologic deficit; the etiology of this deficit was not clearly related to the anesthetic technique. No patients with secondary infection had septic or neurologic complications related to the anesthetic. Both spinal and epidural anesthesia appear to be safe alternatives for patients with secondary HSV infections undergoing cesarean delivery.
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Regional anesthesia · Sep 1990
Clinical Trial Controlled Clinical TrialAlkalinization of mepivacaine accelerates onset of interscalene block for shoulder surgery.
Reports evaluating the effect of alkalinization of mepivacaine on the onset of regional anesthesia have been controversial. The effect of alkalinization of mepivacaine on the onset of interscalene block has not been reported and is the subject of this study. Forty patients received an interscalene block by elicitation of paresthesia with 25-gauge, blunt level needle. ⋯ The duration of block for each observation was determined. The onset was significantly faster for all tested modalities in the pH-adjusted group. No statistically significant differences in the duration of either motor or sensory were found between the study and control groups.
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Regional anesthesia · Sep 1990
Plasma concentrations after high doses of mepivacaine with epinephrine in the combined psoas compartment/sciatic nerve block.
A combination of psoas compartment block and sciatic nerve block was performed with a total dose of 731.5 mg mepivacaine (55 ml, 1.33%) with epinephrine (1:600,000) in patients scheduled for orthopedic surgery on one leg. In 20 patients, arterial blood samples were collected at timed intervals over a 6-hour period to determine the mepivacaine plasma concentration. ⋯ Despite the high dose of mepivacaine, the plasma concentrations stayed below 6.0 micrograms/ml, with one exception, although no clinical signs of local anesthetic toxicity were observed. Plasma pharmacokinetic variables of mepivacaine were as follows: Cmax: 4.22 mg.l-1 (SD, 1.28); Tmax: 0.99 hours (SD, 0.76); T1/2: 3.25 hours (SD, 1.12); CL 0.55 1.hour-1.kg-1.