Regional anesthesia
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The study investigated possible neurotoxic effects of increasing concentrations and doses of bupivacaine administered into the subarachnoid space in dogs. ⋯ Increasing concentrations and doses of hyperbaric bupivacaine solutions increased the incidence of nerve tissue damage, which did not occur with hypobaric solutions. These results should contribute to the further understanding of neurologic complications following spinal anesthesia when large doses of local anesthetics in hyperbaric solutions are used.
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Regional anesthesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of morphine with and without fentanyl for epidural analgesia after major abdominal surgery.
The study compared bolus injection of fentanyl versus morphine to supplement epidural infusion of morphine for pain relief after major abdominal surgery. ⋯ When fentanyl is added continuously to epidural morphine, the resulting higher total serum levels of opioids during prolonged treatment may increase the risk of respiratory depression. Combining the two opioids for the loading dose, however, may be valuable to shorten the onset time of analgesia.
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Regional anesthesia · May 1996
Randomized Controlled Trial Clinical TrialComparison of intravenous nalbuphine infusion versus saline as an adjuvant for epidural morphine.
Radical (three-quadrant) hemorrhoidectomy is a major anorectal surgery that may necessitate aggressive pain management. This study was undertaken to determine whether intravenous nalbuphine infusion as an adjuvant to epidural morphine could offer not only a good quality of pain relief but also a lower incidence of side effects. ⋯ The results suggest that intravenous nalbuphine infusion as an adjuvant for epidural morphine reduces the incidence of side effects without decreasing the quality of pain relief.
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Regional anesthesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialSpinal analgesia during labor with low-dose bupivacaine, sufentanil, and epinephrine. A comparison with epidural analgesia.
The purpose of this investigation was to evaluate the effectiveness and side effects of combined spinal-epidural (CSE) injection of a bupiv-acaine-sufentanil-epinephrine mixture during labor as compared with epidural analgesia alone. ⋯ The CSE mixture induced long-lasting analgesia, with fast onset and without motor block or hypotension. Pruritus and headache were the major drawbacks of this technique.
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Regional anesthesia · May 1996
Nitric oxide synthesis inhibition enhances bupivacaine cardiotoxicity.
There is evidence that local anesthetic-induced seizures may be mediated by receptors for N-methyl-D-aspartate (NMDA) which activate production of nitric oxide (NO). The objective of this study was to determine the effects, if any, of inhibition of NO synthesis on the responses of the central nervous and cardiovascular systems to bupivacaine. ⋯ These results suggest that NO synthase inhibition by L-NAME enhances the cardiac toxicity of bupivacaine, probably by a pharmacokinetic action, and reduces its central nervous system toxicity, probably by a pharmacodynamic action.