Regional anesthesia
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Regional anesthesia · Jul 1997
Comparative StudyIntraneural lidocaine uptake compared with analgesic differences between pregnant and nonpregnant rats.
Pregnant patients need less local anesthetic in order to obtain the same quality of functional block as nonpregnant patients. Our goal was to demonstrate a similarly increased functional susceptibility to local anesthetics in the awake pregnant rat during peripheral nerve block and to investigate the pharmacokinetic and/or pharmacodynamic mechanisms responsible for this phenomenon. ⋯ Block of peripheral neural function is prolonged in pregnant rats, and lidocaine content in the nerve is lower at a specific stage of neural block. These results are consistent with a pharmacodynamic mechanism for increased susceptibility to lidocaine neural block during pregnancy.
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Regional anesthesia · Jul 1997
Randomized Controlled Trial Clinical TrialPostoperative analgesia and antiemetic efficacy after subarachnoid neostigmine in orthopedic surgery.
The efficacy of operatively administered spinal neostigmine to provide analgesia and that of different antiemetics to prevent neostigmine-related nausea and vomiting were evaluated in patients undergoing tibial or ankle reconstruction. ⋯ Subarachnoid neostigmine reduced postoperative pain scores and analgesic requirements. Whether it prolonged the duration of action of diclofenac or enhanced the mechanisms involved in spinal analgesia cannot be determined from these data. Although propofol and droperidol appeared to be more effective during and after surgery, respectively, all neostigmine groups were associated with a high consumption of antiemetics.
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Postdural puncture headache can recur following an epidural blood patch but usually does so within the first week. However, a late recurrence was encountered in a 31-year-old woman with probable lupus vasculitis. ⋯ A review of risk factors for postdural puncture headache and the role of an epidural blood patch suggests a possible explanation for the late recurrence in this case.
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The clinical utility of a new parasacral approach for conduction block of the sciatic nerve was investigated, with critical examination of onset, extent, and success rates when this block was used for surgical procedures below the knee. ⋯ The parasacral approach to the sciatic nerve exhibits a high success rate, resulting in anesthesia of the entire sacral plexus and generally in motor block of the obturator nerve was an interesting observation.