Regional anesthesia
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Regional anesthesia · Nov 1993
Case Reports Randomized Controlled Trial Clinical TrialDirection of catheter insertion and incidence of paresthesias and failure rate in continuous epidural anesthesia: a comparison of cephalad and caudad catheter insertion.
Paresthesias and unblocked segments during continuous epidural anesthesia--sometimes leading to higher doses of local anesthetics--can increase the risk of this technique. A cephalad insertion of the epidural catheter might decrease the incidence of these problems, but this has not been evaluated before in a controlled study. ⋯ Our results support the contention that the catheter should be directed cephalad during insertion for continuous epidural anesthesia.
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Regional anesthesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialThoracic versus lumbar administration of epidural morphine for postoperative analgesia after thoracotomy.
The purpose of this study was to compare the effects of thoracic and lumbar epidural morphine on pulmonary function and analgesia after thoracotomy for pulmonary resection. ⋯ The authors conclude that thoracic epidural morphine administration in patients after thoracotomy results in decreased morphine requirements and the same degree of analgesia as does lumbar administration.
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Regional anesthesia · Nov 1993
Continuous spinal anesthesia: mechanical and technical problems of catheter placement.
Although continuous spinal anesthesia with microcatheters has a number of advantages, there are also some drawbacks: technical problems in advancing the catheter, the possibility of traumatizing neural structures, the development of cauda equina syndrome, and maldistribution of the local anesthetic. ⋯ To take advantage of continuous spinal anesthesia, a meticulous technique is required.
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Regional anesthesia · Nov 1993
Historical ArticleContinuous spinal anesthesia: a historical perspective.
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Regional anesthesia · Nov 1993
ReviewPhysiologic mechanisms by which local anesthetics may cause injury to nerve and spinal cord.
Review evidence for possible physiologic mechanisms by which local anesthetics cause nerve injury was reviewed. ⋯ In rare instances, the clinical use of local anesthetics is associated with neurologic morbidity. The physiologic mechanisms of toxicity for which there is the best evidence are inhibition of fast axonal transport, disruption of the axonal cytoskeleton, axonal degeneration, and ischemic nerve injury. The effects of local anesthetics on nerve blood flow may be related to inhibition of endothelium-dependent vasodilation or interruption of the synthesis of vasodilating prostaglandins. Both the prevention and the treatment of nerve injury caused by local anesthetics requires information that is not yet available about the physiologic and molecular mechanisms for direct neural toxicity of local anesthetics.