Regional anesthesia
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Regional anesthesia · Sep 1989
Continuous high thoracic epidural administration of bupivacaine with sufentanil or nicomorphine for postoperative pain relief after thoracic surgery.
In a prospective study, 40 patients who had undergone thoracotomy for lung resection were investigated. During operation, all patients received intravenous anesthesics, halothane and an initial dose of bupivacaine 0.5% with epinephrine 5 micrograms.ml-1 (5 to 10 ml) by thoracic epidural catheter. One hour after the initial dose of bupivacaine 0.5% with epinephrine, patients were divided in two groups for analgesia, the sufentanil group (50 micrograms sufentanil in 60 ml bupivacaine 0.125%) or the nicomorphine group (3 mg nicomorphine in 60 ml bupivacaine 0.125%) by a continuous epidural infusion (5 to 10 ml.h-1) for three days. ⋯ An inverse visual analogue pain scale (0 to 10 IVAS) showed mean scores above 7.5 for all patients during the three days. Scoring pain relief during exercise showed a significant difference in favor of the sufentanil group on Days 1, 2, and 3 (p less than 0.0008). The mean plasma bupivacaine level doubled every day, 138 ng.ml-1 on Day 1, 290 ng.ml-1 on Day 2, and 596 ng.ml-1 on Day 3.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional anesthesia · Sep 1989
Case ReportsSpinal cord compression following labor and delivery with epidural analgesia.
Transient back pain is not uncommon during pregnancy and the postpartum period. Following an epidural anesthetic, back pain persisted in a postpartum patient beyond the expected period of soreness. Further diagnostic evaluation led to diagnosis and surgical decompression of a herniated thoracic disc.
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Regional anesthesia · Sep 1989
Randomized Controlled Trial Clinical TrialAlkalinization of epidural 0.5% bupivacaine for cesarean section.
Controversial results have been published in the literature concerning the efficacy of alkalinization of solutions of local anesthetics to shorten the time to onset of sensory block. Fifty-two parturients scheduled for cesarean section at term under epidural anesthesia were randomly allocated to one of four groups: group 1, 0.5% plain bupivacaine (pH = 5.38 +/- 0.05); group 2, 0.5% bupivacaine pH-adjusted with 1.4% sodium bicarbonate (pH = 6.87 +/- 0.01); group 3, 0.5% bupivacaine with 1:200,000 epinephrine (pH = 4.80 +/- 0.04); and group 4, 0.5% bupivacaine pH-adjusted with 1:200,000 epinephrine (pH = 6.68 +/- 0.01). The time to onset of the sensory block was evaluated using a nerve stimulator technique. ⋯ No differences in the characteristics of the onset of the sensory block were observed with epinephrine-containing solutions nor with pH-adjusted local anesthetics. The maximal degree of motor blockade was not significantly different in the four groups. We conclude that alkalinization of a 0.5% bupivacaine solution is not an effective way to shorten the latency of epidural block for cesarean section.
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Regional anesthesia · Sep 1989
Comparative StudyBupivacaine/butorphanol/epinephrine for epidural anesthesia in obstetrics: maternal and neonatal effects.
The effects of epidural bupivacaine/butorphanol with and without 1:300,000 epinephrine on maternal analgesia, uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid base status and the neurologic and adaptive capacity scores (NACS) were compared in 33 parturients during labor and delivery. Patients in Group I (n = 17) received 0.25% bupivacaine plus 1 mg butorphanol plus 1:300,000 epinephrine, and those in Group II (n = 16) received the same agents without the epinephrine. Addition of epinephrine to bupivacaine/butorphanol did not have any adverse effects on uterine activity, duration of first or second stages of labor or fetal heart rate parameters. ⋯ Apgar scores, neonatal acid base status and the NACS were equally good and did not differ significantly between the two groups. Duration of analgesia was significantly longer in Group I as compared to Group II patients (177.5 +/- 11 versus 131.8 +/- 10 minutes, p less than 0.01). It is concluded that addition of epinephrine 1:300,000 to bupivacaine/butorphanol during epidural anesthesia in the normal parturient has no adverse effects on the mother, fetus or neonate or on the progress of labor and it significantly prolongs the duration of analgesia.
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Several studies have indicated that the addition of sodium bicarbonate to solutions of local anesthetics to raise the pH closer to the pKa shortens the latency, increases the intensity, and prolongs the duration of the resultant neural blockade. However, the addition of too much bicarbonate will cause precipitation, and this may result in the injection of particulate free base along with the solution. The present study was carried out to determine the maximal amount of sodium bicarbonate that can be added to each of the amide local anesthetics without the formation of a precipitate, and, thus, to construct a pH adjustment schedule to simplify the alkalinization of local anesthetics in clinical practice.