Regional anesthesia
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Regional anesthesia · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialSkin blood flow after intradermal injection of ropivacaine in various concentrations with and without epinephrine evaluated by laser Doppler flowmetry.
Skin blood flow changes after intradermal injection of ropivacaine in various concentrations with or without epinephrine were investigated using laser Doppler flowmetry. ⋯ The combination of ropivacaine and adrenaline did not accentuate but instead diminished the vasoconstrictive effect of epinephrine.
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Regional anesthesia · Nov 1992
Comparative StudyThoracic paravertebral block in chronic postoperative pain.
Chronic postoperative pain in thoracic dermatomes is common. The most frequently used methods of pain relief in this area are posterior multidermatomal intercostal nerve or thoracic epidural blocks. Compared with these methods, thoracic paravertebral block may have some advantages. Usually only one injection is needed, and the use of larger volumes of local anesthetic (up to 25 ml) results in widespread unilateral analgesia including sympathetic block without the potential risk of hypotension and motor block associated with epidural block. ⋯ Thoracic paravertebral block proved to be a reliable and safe technique for unilateral pain relief in chronic post-thoracotomy pain.
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Regional anesthesia · Nov 1992
Case ReportsWhen to remove an epidural catheter in a parturient with disseminated intravascular coagulation.
Pain from labor and delivery is often attenuated with epidural anesthesia. A complication of indwelling epidural catheters is intraspinal hematoma. The development of a bleeding diathesis can worsen complications markedly. ⋯ Frequent assessment of neurologic status is important until the underlying cause of the coagulopathy can be treated and the bleeding resolves. If there is no indication of intraspinal bleeding, we recommend removing the catheter because of potential catheter migration. If bleeding is occurring around the catheter insertion site and possibly in the epidural or subarachnoid space, the catheter may be left in place to tamponade the insertion site. In cases of intraspinal hematoma, which can cause neurologic deficits, immediate decompression surgery is needed.
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Regional anesthesia · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia with epidural meperidine after elective cesarean section.
We report the first controlled analysis of the use of patient-controlled epidural meperidine. This randomized, prospective study compares the efficacy and safety of patient-controlled epidural meperidine to conventional intramuscular meperidine for the management of postoperative pain after elective cesarean delivery. ⋯ Patient-controlled epidural meperidine after cesarean delivery more effectively manages postoperative pain than conventional intramuscular use. The technique is preferred by both patients and nursing staff and can be used in the ward setting with appropriate organization and education. Respiratory depression, if it occurs, should present early after epidural bolus administration.