Regional anesthesia
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Regional anesthesia · Nov 1989
Randomized Controlled Trial Clinical TrialEffect of diluting fentanyl on epidural bupivacaine during labor analgesia.
In a randomized prospective study carried out on 60 laboring primiparous parturients, fentanyl 80 micrograms, either in 2 ml or in 8 ml, was added to 12 ml of 0.25% bupivacaine administered epidurally for pain relief. The aims of this protocol were to evaluate the effect of varying the volume of fentanyl added to epidural bupivacaine on the quality and duration of labor analgesia. ⋯ The incidence of pruritus was higher in the fentanyl-diluted group (43% versus 23%). No clinical advantage was found in this study, therefore, when fentanyl 80 micrograms was added to 0.25% bupivacaine.
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Regional anesthesia · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialBrachial plexus block with opioids for postoperative pain relief: comparison between buprenorphine and morphine.
The effectiveness of buprenorphine and morphine, administered into the brachial plexus sheath, was evaluated in 40 patients, aged 18-90 years. All patients received 40 ml of 0.5% bupivacaine, injected into the brachial plexus sheath using the supraclavicular technique. In addition, the 20 patients in Group I received morphine hydrochloride (50 micrograms/kg), while the 20 patients in Group II received buprenorphine hydrochloride (3 micrograms/kg). ⋯ A significant difference in the quality of analgesia was found; and was consistently superior with buprenorphine as compared with morphine. The duration of analgesia was nearly twice as long in the buprenorphine group as in the morphine group (35.05 +/- 1.95 hour versus 18.25 +/- 1.15 hour). We conclude that buprenorphine injection into the brachial plexus sheath is an efficient way to assure control of postoperative pain after upper limb surgery.
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Regional anesthesia · Sep 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of pH adjustment of 0.5% bupivacaine on the latency of epidural anesthesia.
pH adjustment of lidocaine and 2-chloroprocaine has been reported to decrease the latency of epidural anesthesia (EA). The effect of alkalinization of bupivacaine on onset of surgical anesthesia has not been adequately studied to date. To determine what effect raising the pH of 0.5% bupivacaine has on the latency of EA in patients undergoing lower extremity surgery, we performed a randomized, double-blind study. ⋯ The pH of the LA used for Group I was 6.96 +/- 0.01 and for Group II was 5.33 +/- 0.11. No statistically significant difference was found between the anesthetic parameters tested in each group. On this basis, we find no advantage of pH adjustment of 0.5% bupivacaine for EA.
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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 · Jul 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of continuous epidural analgesia with sufentanil and bupivacaine during and after thoracic surgery on the plasma cortisol concentration and pain relief.
The effect of continuous epidural analgesia with bupivacaine 0.125% and sufentanil 0.83 micrograms.ml-1 on the plasma cortisol concentration and postoperative pain relief was compared with that of intermittent intravenous peroperative and on-demand intramuscular postoperative analgesia with nicomorphine 0.2 mg.kg-1. The study was performed on two groups of ten patients for three consecutive days after thoracic surgery. In the epidural group, a better quality of analgesia was found as measured with the Inverse Linear Analgesia Scale (ILAS) (1 = severe pain, 10 = no pain) than in the group that received intramuscular analgesia. ⋯ L-1 on day 1. The measured mean plasma cortisol concentration was found to exceed normal limits (150-700 nmol. L-1) only in the systemic group and only on day 1.