Regional anesthesia
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Spinal anesthesia is used for ambulatory surgical procedures. We provide an overview of the use of local anesthetics, use of continuous techniques, and use of adjuncts for optimization of spinal anesthesia for ambulatory surgery. ⋯ Ambulatory spinal anesthesia may be optimized by selection of dose, concentration, and baricity of local anesthetic. Use of a continuous technique or an intrathecal adjunct may also be valuable means to optimize spinal anesthesia for ambulatory surgery.
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Regional anesthesia · Nov 1997
ReviewDoes epidural analgesia during labor affect the incidence of cesarean delivery?
There is substantial evidence that there is an increased incidence of cesarean delivery among patients who receive epidural analgesia during labor. The controversy as to whether there is a causal relationship between epidural analgesia and cesarean delivery. Two prospective, randomized studies suggest that epidural analgesia may increase the incidence of operative delivery in laboring women. ⋯ It is important to consider the impact of epidural analgesia on the total population of obstetric patients. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate. Finally, physicians should remember that pain relief is itself a worthy goal.
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Regional anesthesia · Nov 1997
ReviewProgress in the development of ultra-long-acting local anesthetics.
Local anesthetic agents with a duration of action longer than the currently available local anesthetics could have widespread clinical application for the treatment of both chronic and acute pain. Over the last several decades, several different approaches have been used in the development of ultra-long-acting agents. There are currently promising preparations in development which may prove clinically useful in the near future. ⋯ Although encouraging results have been reported in the literature, there is currently no agent or delivery system that has shown reliable and practical prolongation of local anesthetic effect in humans. There have been several encouraging reports in animals that have shown local anesthetic effects lasting up to several days, but these results must be validated and then performed in human studies before a clinically useful agent is found. Further research is warranted.