Regional anesthesia
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Regional anesthesia · Sep 1997
Randomized Controlled Trial Clinical TrialDoes metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?
Recent studies have shown that metoclopramide may decrease postoperative narcotic requirements in patients undergoing second-trimester induced abortions or prosthetic hip surgery. It is often used to decrease the incidence of nausea and vomiting in the patient undergoing cesarean delivery under regional anesthesia. If metoclopramide were found to be an analgesic adjunct in these patients, it would offer an additional impetus for its routine use. ⋯ This study demonstrates that metoclopramide decreases intraoperative nausea but does not supplement analgesia in patients undergoing elective cesarean delivery.
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Regional anesthesia · Sep 1997
Clinical TrialSuperficial and deep cervical plexus block for carotid artery surgery: a prospective study of 1000 blocks.
Cervical plexus blocks are performed for carotid surgery to allow neurological assessment of the awake patient. The aim of this study was to establish the frequency of success, complications, and patient acceptance of the technique. ⋯ We conclude that superficial and deep cervical plexus block has a high success rate, low complication rate, and high patient acceptance rate. Caution should, however, be exercised to ensure a low intravascular injection rate which is of most concern with this technique, because blood was aspirated in 30% of patients during performance of the block.
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Regional anesthesia · Sep 1997
Clinical TrialLidocaine does not depress reflex dilation of the pupil.
Pupillary dilation in response to dermatomal electrical stimulation is one method of determining sensory block level during combined epidural and general anesthesia. Use of this technique may, however, be confounded by systemic absorption of epidurally administered local anesthetics. Accordingly, the effects of intravenous lidocaine on the magnitude and duration of reflex pupillary dilation were evaluated. ⋯ Typical plasma lidocaine concentrations observed during epidural anesthesia are unlikely to prevent the use of pupillary responses to evaluate sensory block level.
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Regional anesthesia · Sep 1997
Case Reports Clinical TrialDoes combined spinal-epidural analgesia with subarachnoid sufentanil increase the incidence of emergency cesarean delivery?
The purpose of this review was to determine if patients who receive combined spinal-epidural (CSE) analgesia with subarachnoid sufentanil have an increased incidence of emergency cesarean delivery for fetal distress when compared with patients who receive systemic or no medication (S/NM) for labor analgesia. ⋯ This experience indicates that patients who receive CSE analgesia do not have a higher incidence of emergency cesarean delivery than patients who have S/NM for labor analgesia. Emergency cesarean section for fetal distress within 90 minutes of the administration of intrathecal sufentanil only occurred in association with obstetric factors. However, caution should be exercised in extrapolating these results to other practice settings, particularly high-risk referral centers.
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Regional anesthesia · Sep 1997
Clinical TrialExperience with gabapentin for neuropathic pain in the head and neck: report of ten cases.
Gabapentin is an oral antiepileptic agent with an unknown mechanism of action. Recent case reports have suggested that gabapentin may be effective in the treatment of a variety of neuropathic pain states. This report presents baseline and follow-up data on ten patients who were treated with gabapentin when other pharmacologic interventions failed to relieve their neuropathic pain. ⋯ The results suggest that gabapentin may be effective in the management of some cases of neuropathic pain in the head and neck. However, controlled, double-blind longitudinal studies are needed to evaluate this possibility.