Regional anesthesia
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Regional anesthesia · Sep 1996
Case ReportsPeripheral nerve catheterization in the management of terminal cancer pain.
Peripheral nerve catheterization techniques were used in two patients with severe pain associated with the terminal stages of metastatic cancer. The first patient had severe upper limb pain and lymphedema secondary to breast carcinoma, and the second patient had an acutely ischemic leg secondary to pelvic obstruction from an ovarian tumor. The goal of treatment was to relieve the pain, which was resistant to opioid drugs, and to optimize the quality of life that remained, estimated to be only a few weeks. ⋯ Peripheral nerve catheterization proved beneficial in two patients who presented with difficult pain management problems and should be more widely considered for the relief of severe cancer-related pain in both the upper and lower limbs.
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Regional anesthesia · Sep 1996
Clinical TrialAnalgesic efficacy and side effects of subarachnoid sufentanil-bupivacaine administered to women in advanced labor.
Previous studies of labor analgesia using subarachnoid sufentanil (alone or with adjuvants) have focused on women in the early first stage of labor. This study prospectively evaluated analgesia and side effects of subarachnoid sufentanil (10 micrograms) plus bupivacaine (2.5 mg) in parturients with cervical dilation of 7 cm or more. ⋯ In parturients with cervical dilation of 7 cm or more, subarachnoid sufentanil-bupivacaine produces rapid analgesia with an effective duration of approximately 130 minutes.
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Regional anesthesia · Sep 1996
Celiac plexus block. Retrocrural computed tomographic anatomy in patients with and without pancreatic cancer.
Neurolytic celiac plexus block is often performed for analgesia from pancreatic cancer, but it is not known if the cancer alters the anatomy relevant to the successful performance of retrocrural celiac plexus block. ⋯ The predicted success of stimulated retrocrural celiac plexus block differed between patients with and without pancreatic cancer. These findings have implications for the performance of celiac plexus block.
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The object of this study was to measure the clinically relevant depth of the posterior epidural space (ES) while placing subarachnoid catheters. ⋯ The posterior ES has been found to be somewhat larger and more variable than previously described. The findings provide clinical confirmation of recent radiologic and cadaveric studies, which portray a posterior ES of variable size and complex shape. These findings have implications for cannulation and use of epidural therapy as well as for the combined catheter epidural and single-dose spinal technique.
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Regional anesthesia · Sep 1996
Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease.
Cryomicrotome section is a means of anatomic examination with minimal artifact ideally suited to delineating details of tissue relationships in the epidural space. In the past, healthy adult lumbar levels have been studied by this method. This report extends observations to other regions of the vertebral column, other age groups, and some abnormal conditions. ⋯ Variations in epidural anatomy due to vertebral level, age, and disease may alter the ease of epidural entry and passage of catheters and injected solution.