Regional anesthesia
-
Regional anesthesia · Sep 1997
Comparative StudyComparative local anesthetic efficacy and pharmacokinetics of epidurally administered ropivacaine and bupivacaine in the sheep.
Ropivacaine is the S(-) propyl homolog of bupivacaine and mepivacaine. Studies in humans have confirmed the results of studies in laboratory animals that ropivacaine is a long-acting local anesthetic with an anesthetic profile similar to bupivacaine. Acute, intravenous systemic toxicity studies have been conducted in sheep and dogs. Local anesthetic efficacy has been studied after epidural administration in the dog. This study was initiated to determine the local anesthetic efficacy and pharmacokinetics of ropivacaine and bupivacaine after epidural administration in an experimental sheep model and to evaluate the sheep model as a model of experimental epidural anesthesia. ⋯ Ropivacaine produces sensory and motor blockade which is similar to that produced by equal concentrations of bupivacaine after epidural administration in the sheep. Peak serum concentrations produced no signs of systemic toxicity. The results of this study are consistent with previously published data from studies in laboratory animals and humans. The sheep model of experimental epidural anesthesia appears to be a clinically relevant method to evaluate experimental local anesthetics.
-
Regional anesthesia · Sep 1997
Case ReportsAdrenocorticotropic hormone infusion as a novel treatment for postdural puncture headache.
In two patients, one scheduled for epidural anesthesia and the other for placement of a spinal catheter for operative procedures, severe postdural puncture headache developed and was refractory to conservative therapy. ⋯ A single treatment with ACTH may offer an alternative therapy in the treatment of postdural puncture headache.
-
Regional anesthesia · Sep 1997
Case ReportsUnexplained neurologic deficit after uneventful combined spinal and epidural anesthesia for cesarean delivery.
Neurologic deficits after spinal and epidural anesthesia are uncommon and have a variety of pathophysiologic mechanisms. Local anesthetic neurotoxicity may occur, although subarachnoid bupivacaine has an unblemished clinical record. ⋯ Drug-induced neurotoxicity is a possible explanation, although the exact etiology is uncertain.
-
For the past 16 years the combined spinal-epidural (CSE) technique has been extensively researched and developed to the point where it is now in widespread use. Along with the use of low-dose mixtures of local anesthetics and opioids, and the introduction of fine-gauge pencil-point needles, CSE is being increasingly recognized as another important addition to the armamentarium of the anesthesiologist. ⋯ The CSE technique offers many potential advantages over continuous epidural or subarachnoid methods alone, including a reduction in drug dosage, the ability to eliminate motor blockade and to achieve highly selective sensory blockade and optimize analgesia. These features hold great promise for minimizing the hazards and side effects of traditional epidural and subarachnoid techniques. Controversial fears, risks, and pitfalls of the CSE technique and of continuous epidural and subarachnoid methods are debated and discussed.
-
Regional anesthesia · Sep 1997
Clinical TrialCulture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children.
Continuous epidural analgesia has been used with increasing frequency to provide postoperative pain relief for children. Epidural space infection is a potential complication of epidural catheter placement. This study investigated the incidence of bacterial colonization on lumbar and caudal epidural catheter tips in postoperative pediatric patients. ⋯ The results of this study suggest that the risk of clinical epidural infection associated with caudal or lumbar postoperative catheters is low. However, the incidence of epidural catheter tip colonization is increased with the caudal route of insertion, and the bacteria differ from those cultured from the lumbar insertion site.