Regional anesthesia
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Regional anesthesia · Jan 1997
Clinical TrialExtended epidural catheter infusions with analgesics for patients with noncancer pain at their homes.
Patients with severe, noncancer pain unresponsive to epidural steroid injections are frequently referred for implantation of a permanent intraspinal device or for surgery. An alternative approach has been evaluated, which involves extended epidural catheter infusions of analgesics. ⋯ Temporary lumbar epidural catheter infusions represent an option between lumbar epidural steroid injections and more invasive and expensive modalities. The technique is effective in relieving chronic low back pain for extended periods, reducing its long-term intensity, and in some cases abolishing it.
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Regional anesthesia · Jan 1997
The hypothesis that antagonism of fentanyl analgesia by 2-chloroprocaine is mediated by direct action on opioid receptors.
Although 2-chloroprocaine continues to be a useful drug for epidural anesthesia in obstetrics, it has the anomalous action of decreasing the analgesic effectiveness of subsequently administered epidural fentanyl. Some investigators have suggested that 2-chloroprocaine may act at an opioid receptor site to antagonize the effects of fentanyl. The purpose of our studies was to investigate this hypothesis. ⋯ Although 2-chloroprocaine has binding affinity at mu and kappa opioid receptor sites, it does not appear to act through an opioid receptor to antagonize the physiologic effects of fentanyl.
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The use of regional anesthesia in patients receiving anticoagulants is controversial. The purpose of this review is to document the incidence of neurologic complications with insertion and removal of an epidural catheter in patients receiving oral anticoagulants and antiplatelet medication. ⋯ Epidural catheter placement and removal in patients taking oral anticoagulants appears to be safe. Careful monitoring of the patient for evidence of spinal hematoma after epidural catheter removal is recommended.
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Regional anesthesia · Nov 1996
Randomized Controlled Trial Clinical TrialKetamine potentiates analgesic effect of morphine in postoperative epidural pain control.
Ketamine is currently the only N-methyl-D-aspartate receptor channel blocker in clinical use. This study evaluated the analgesic efficacy of epidurally coadministered ketamine and morphine in postoperative pain control. ⋯ Ketamine, although not itself an epidural analgesic agent, potentiates the analgesic effect of morphine, especially when administered as a pretreatment. The resulting lowered dosage of epidural morphine needed for postoperative pain relief reduces, in turn, the incidence of side effects. Pretreatment of patients with ketamine epidurally, followed by injections of combined morphine and ketamine could be a promising new analgesic regimen.