Regional anesthesia
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Regional anesthesia · Jan 1997
ReviewIdentification of the epidural space: is loss of resistance to air a safe technique? A review of the complications related to the use of air.
The major determinant of successful epidural anesthesia is the localization of the epidural space. The manual loss of resistance technique is widely used by anesthesiologists in identifying the epidural space. Should air or saline be used in detecting the point of loss of resistance? No consensus exists as to which technique is superior, and individual providers currently use the technique with which they are most comfortable. The incidence of adverse effects associated with the use of epidural air is unknown and may be underreported as the effects may be unrecognized or considered trivial. The authors comprehensively review the complications of epidural air from published reports. ⋯ The potential complications associated with the use of air for identifying the epidural space with the loss of resistance technique may outweigh the benefits. The use of saline to identify the epidural space may help to reduce the incidence of these complications.
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Regional anesthesia · Jan 1997
Comparative StudyFailure of meperidine to anesthetize human median nerve. A blinded comparison with lidocaine and saline.
Although meperidine safely produces clinical spinal anesthesia, the responsible mechanism is unknown. This study was undertaken to test the possibility that this drug acts as a local anesthetic by investigating its ability to inhibit conduction in a human peripheral nerve. ⋯ Meperidine produced no signs of local anesthesia, even when given at a dose (75 mg) and concentration (1.5%) that consistently produced systemic side effects. Thus, the coequivalent ability of meperidine and lidocaine to produce spinal anesthesia contrasts with their discordant ability to produce local anesthesia. This disparity suggests that meperidine may produce spinal anesthesia through mechanisms other than inhibition of sodium channel function.
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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 · 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.