Regional anesthesia
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Regional anesthesia · May 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of pH adjustment of 2% mepivacaine on epidural anesthesia.
Two-hundred men, scheduled for elective meniscectomy under epidural anesthesia, were randomly assigned to receive either a standard 2% mepivacaine solution (n = 100) or a pH adjusted 2% mepivacaine solution (pHAS, n = 100). The pHAS was freshly prepared before the block by adding 0.1 mEq of NaHCO3 per ml of mepivacaine solution. After a test-dose, the anesthetic solution was injected to produce a level of sensory anesthesia to T10. ⋯ Patients in the pHAS group showed a significant shortening of onset time in T10 and in S2 segment (p less than .001). Grade 3 motor blockade was achieved in the same number of patients, but a faster motor block was observed in the pHAS group (p less than .05). Regression of both sensory and motor blockade in the two groups was not significantly different.
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Regional anesthesia · May 1989
Randomized Controlled Trial Comparative Study Clinical TrialEpidural morphine or butorphanol augments bupivacaine analgesia during labor.
To determine the efficacy and the safety of epidural morphine or butorphanol combined with bupivacaine, 40 healthy parturients were studied during labor and delivery. All patients received an epidural test dose of 2 ml of 0.5% bupivacaine. Patients were then randomly assigned to receive one of four epidural regimens in a double-blind fashion: 0.25% bupivacaine + 1 mg butorphanol (Group I), 0.25% bupivacaine + 2 mg butorphanol (Group II), 0.25% bupivacaine + 2 mg morphine (Group III), or 0.25% bupivacaine alone (Group IV). ⋯ All neonates were vigorous at 5 minutes and had good Apgar Scores, umbilical cord acid base status, and Neurological Adaptive Capacity Scores. The authors conclude that adding small doses of either morphine or butorphanol to epidural bupivacaine during labor is effective and safe. Butorphanol may be preferable since none of the patients experienced pruritus.
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Clinical TrialTemperature changes and shivering after epidural anesthesia for cesarean section.
Changes in bladder, tympanic membrane, and skin temperature were monitored in two groups of parturients after they received epidural anesthesia for elective Cesarean sections. Group 2 patients (n = 21) received warm intravenous crystalloid and prep solutions as well as extra body covering, whereas Group 1 patients (n = 19) did not. ⋯ The peak onset of shivering occurred within 10 minutes of epidural anesthesia and preceded any significant decline in core temperature. However, a positive correlation was noted between shivering and bladder temperature decline over the full course of Cesarean section.
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe treatment of patients with multiple rib fractures using continuous thoracic epidural narcotic infusion.
The incidence of tracheostomy, length of intensive care unit (ICU) and total hospital stay, and duration of ventilatory support were evaluated prospectively in 28 patients who had multiple rib fractures. The patients were randomly divided into two groups: 13 patients were given standard morphine parenteral analgesia and constituted the control group (Group 1), and 15 patients had thoracic epidural catheter placement within 72 hours from the time of admission to the ICU (Group 2). ⋯ Group 2 patients also had a lower incidence of tracheostomy versus control patients (6.7 +/- 6.7% vs. 38.5 +/- 14.0%, p less than 0.05). The authors believe that continuous thoracic epidural morphine analgesia may provide distinct pulmonary and economic advantages in patients with multiple rib fractures.
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Clinical TrialThe effect of rate of infusion on continuous epidural analgesia for labor and delivery.
The authors previously reported that if a loading dose of 50 mg bupivacaine was followed by infusion of 0.0625% bupivacaine (12.5 mg/hr), supplemental doses to achieve satisfactory analgesia for labor and delivery were required in 50% of patients. The current study was done to determine whether increasing the dose from 12.5 to 25 mg/h would eliminate the need for supplemental injections. Twenty-three healthy parturients were randomly assigned to one of two groups--Group I: 0.125% bupivacaine at 20 ml/hr (25 mg/hr); or Group II: 0.25% bupivacaine at 10 ml/hr (25 mg/hr). ⋯ Pharmacokinetic data were similar in both groups. Using a dose of 25 mg/hr resulted in 74% of the patients obtaining adequate analgesia for labor and delivery. This improvement over the 50% success rate in the previous study, was achieved without any evidence of toxicity.