Regional anesthesia
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In 100 pregnant women, identification of the epidural space was performed by a modified drip method. A saline infusion was prepared, leaving the distal 40 cm of infusion tubing full of air, and then attached to the hub of a Tuohy needle. ⋯ There were no unintentional dural punctures. This technique has advantages over the hanging drop and the manual loss of resistance techniques.
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Regional anesthesia · Jul 1991
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of postcesarean epidural morphine analgesia by single injection and by continuous infusion.
To assess the relative efficacy and incidence of side effects of a single injection versus a continuous infusion of epidural morphine sulfate (MS) in the postcesarean population, the authors report a prospective, randomized, double-blind study. Thirty-one patients received either a 5-mg MS bolus and subsequent saline infusion (n = 13) or a 2.6-mg MS bolus and subsequent MS infusion at 0.1 mg/hour (n = 18), such that after 24 hours both groups had received a total MS dose of 5 mg. ⋯ The authors conclude that in this population, continuous epidural morphine infusion offers no obvious advantage over single morphine bolus therapy. However, the theoretical merits of continuous opioid infusion therapy are discussed.
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Regional anesthesia · Jul 1991
Randomized Controlled Trial Clinical TrialIntravenous lidocaine does not cause shivering-like tremor or alter thermoregulation.
We tested the hypotheses that systemic absorption of epidural lidocaine: (1) contributes to the shivering-like tremor seen during epidural anesthesia by causing central nervous system disinhibition of spinal reflexes, or (2) activates or alters thermoregulatory mechanisms. In a double-blind, placebo, cross-over study, nine healthy volunteers were given intravenous lidocaine (or saline) to approximate the plasma levels of lidocaine achieved during epidural anesthesia for major abdominal surgery. ⋯ Central temperatures, peripheral vasoconstriction, tremor and clonus were unaffected by intravenous lidocaine. We conclude that the systemic absorption of epidural lidocaine does not contribute to tremor or shivering by these mechanisms.
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Regional anesthesia · Jul 1991
Randomized Controlled Trial Comparative Study Clinical TrialComparison of onset time between 0.5% bupivacaine and 3% 2-chloroprocaine with and without 75 micrograms fentanyl.
We tested the hypothesis that the addition of 75 micrograms fentanyl to 0.5% bupivacaine would reduce the onset time of surgical anesthesia for cesarean delivery to equal the onset time of 3% 2-chloroprocaine and would have no effect when added to 3% 2-chloroprocaine. Fentanyl was found to reduce the onset time of bupivacaine to equal the onset time of 2-chloroprocaine and have no effect when added to 2-chloroprocaine.