Regional anesthesia
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Regional anesthesia · Mar 1997
Randomized Controlled Trial Clinical TrialSubarachnoid meperidine-morphine combination. An effective perioperative analgesic adjunct for cesarean delivery.
Low-dose subarachnoid morphine provides effective perioperative analgesia but may be associated with a transient period of inadequate pain relief between the regression of local anesthetic block and the onset of morphine's analgesic effect. We hypothesized that this period of suboptimal analgesia could be avoided by adding meperidine, a rapid-acting, intermediate-duration opioid. ⋯ The subarachnoid combination of meperidine-morphine provided more uniform analgesia, higher satisfaction, and a lower requirement for intravenous narcotic supplementation than either morphine or meperidine alone in patients recovering from cesarean delivery.
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Regional anesthesia · Mar 1997
Randomized Controlled Trial Clinical TrialPreemptive analgesia in children. Does it exist?
Preemptive analgesia has been evident in animals, but few adult human studies exist demonstrating this concept exist, and there are fewer still in children. Caudal epidural blocks with local anesthetics are often placed for postoperative analgesia in children. This study evaluated whether these blocks are more effective when placed prior to surgical incision. ⋯ Although preemptive analgesia has been successfully demonstrated in some earlier clinical studies, our results indicate that pre- and postincisional caudal epidural blocks with 0.25% bupivacaine were equally effective in children.
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Regional anesthesia · Mar 1997
Comparative StudyLong-tapered double needle used to reduce needle stick nerve injury.
Needle trauma may cause peripheral nerve injuries during performance of peripheral nerve block. ⋯ The long-tapered needles produced the least number of transected nerve fibers after sciatic nerve puncture.
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Regional anesthesia · Mar 1997
Case ReportsAnesthetic management of a parturient with an incompletely resected cerebral arteriovenous malformation.
The anesthetic, neurosurgical, and obstetric literature regarding management of parturients with intracranial arteriovenous malformations is relatively sparse. A case report is given of a parturient, with a recent subtotal resection of a cerebral arteriovenous malformation, who presented for delivery of a viable male fetus. ⋯ The available obstetric and neurosurgical literature does not offer firm recommendations for the optimal route of fetal delivery or the timing of neurosurgical resection of an arteriovenous malformation in the parturient. Anesthetic management is predicated on the principles of minimizing the cardiovascular changes of labor and preventing involuntary Valsalva maneuvers during the second stage of labor. Both of these goals are readily accomplished with epidural anesthesia.
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Regional anesthesia · Mar 1997
Epidural space as a Starling resistor and elevation of inflow resistance in a diseased epidural space.
The origin and the presence of negative pressure in the epidural space as well as the relationship of the extent of epidural anesthesia to epidural pressure has long been a subject of controversy. To further elucidate epidural pressure and its time course, the pressure at the needle tip was continuously measured as it traversed the interspinous ligament and the ligamentum flavum. ⋯ Volume-pressure-flow relationships in the epidural space can be explained by a model in which epidural and subarachnoid pressures are inextricably related with the Starling pressure, dependent on the subarachnoid pressure. This model suggests reasons why spread of anesthetics might be difficult to predict.