Regional anesthesia
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Regional anesthesia · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialContinuous spinal analgesia. Comparison between patient-controlled and bolus administration of plain bupivacaine for postoperative pain relief.
Adequate postoperative pain relief has been achieved in orthopedic patients by subarachnoid bolus administration of plain bupivacaine. This prospective randomized study compares bolus injections of bupivacaine with a patient controlled infusion via subarachnoid 28-gauge microcatheters for postoperative analgesia after elective hip replacement. ⋯ In spite of a higher incidence of technical problems, patient-controlled analgesia with a continuous background infusion via microspinal catheters provides more effective postoperative analgesia, without hemodynamic or respiratory side effects, than bolus administration.
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Regional anesthesia · Mar 1997
Randomized Controlled Trial Clinical TrialAmbulatory combined spinal-epidural analgesia for labor. Influence of epinephrine on bupivacaine-sufentanil combination.
Subarachnoid sufentanil 5 micrograms during labor is known to have variable results. However, subarachnoid sufentanil 5 micrograms plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 micrograms to this mixture. ⋯ This minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 +/- 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.
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Regional anesthesia · Mar 1997
Randomized Controlled Trial Clinical TrialDetection of intravascular epidural catheters using 2-chloroprocaine. Influence of local anesthetic dose and nalbuphine premedication.
Detecting the intravascular placement of epidural catheters is essential to avoid local anesthetic toxicity. Small doses of intravenous local anesthetics produce changes in sensorium and are often used to test newly placed epidural catheters. Many parturients receive nalbuphine for analgesia prior to epidural catheter placement. This study examines how nalbuphine premedication influences symptoms following intravenous 2-chloroprocaine. ⋯ This study suggests that patients who receive nalbuphine for analgesia prior to epidural placement will be more likely to report symptoms after receiving intravenous 2-chloroprocaine during epidural test dosing.
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Regional anesthesia · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of clonidine and epinephrine in lidocaine for cervical plexus block.
Carotid endarterectomy under cervical plexus block offers the advantage of awake neurologic assessment. The hypothesis was tested that the addition of clonidine 5 micrograms/mL to lidocaine 1.5% for the block is as effective clinically as the addition of epinephrine 5 micrograms/mL but without the associated tachycardia. ⋯ Clonidine 5 micrograms/mL is a useful additive to lidocaine 1.5% for cervical plexus block to reduce the incidence of tachycardia; however, omission of epinephrine results in higher serum lidocaine levels.
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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.