Regional anesthesia
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Clinical TrialAnalgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain: a placebo controlled study.
The analgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain was studied. Lidocaine or placebo was infused intravenously in ten healthy volunteers on 2 separate days according to a double-blind, randomized, cross-over design. Analgesia was assessed by argon laser-induced sensory and pain thresholds and pain evoked potentials after doses of 0.7, 1.85 and 3.7 mg/kg of lidocaine, infused over 15, 45 and 75 minutes, respectively. ⋯ Although administration of the highest dose of lidocaine (mean plasma concentration, 8.5 mumol/l) caused significant increases in pain and sensory thresholds, the magnitude of these increases was no greater than those that occurred during placebo infusion. The power of the pain evoked potentials was significantly decreased by the highest dose of lidocaine (p = 0.0024) compared with placebo. These results probably reflect that the effect of lidocaine on subjective pain perception might be caused primarily by sedation.
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Clinical TrialContinuous spinal anesthesia with hyperbaric bupivacaine: a dose-response analysis.
Continuous spinal anesthesia (CSA) with hyperbaric bupivacaine (0.75% bupivacaine in 8.25% dextrose and water) was administered to 27 adult males for transurethral endoscopic surgery. Patients were randomized to receive either 3.75, 7.5 or 10 mg hyperbaric bupivacaine in a double-blind fashion. A 20-gauge nylon catheter was inserted at the L3-4 interspace, via an 18-gauge Tuohy-Schliff needle, extending only 2 cm into the subarachnoid space. ⋯ The role of the subarachnoid catheter in the dispersion and distribution of bupivacaine within the subarachnoid space was studied in a model spinal canal system and compared with the distribution of bupivacaine administered via a standard 25-gauge spinal needle. No significant differences were found in the distribution of bupivacaine with either method of injection. The distribution of hyperbaric bupivacaine within the subarachnoid space appears to be related to baricity but is unrelated to administration via needle or catheter.
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialIntercostal nerve block for minor breast surgery.
Two anesthetic procedures, intercostal nerve block (ICNB) and general anesthesia, were evaluated in 45 female patients scheduled for minor breast surgery. The study was designed to compare ICNB with general anesthesia for breast surgery with respect to efficacy, surgical stress and postoperative analgesia and to evaluate epinephrine and ornipressin as vasoconstrictors in the local anesthetic solution. Thirty patients received ICNB of T3-T7 unilaterally using 2% lidocaine plus epinephrine (15 patients, Group A) and 2% lidocaine plus ornipressin (15 patients, Group B). ⋯ Before and during surgery, epinephrine and norepinephrine plasma levels were highest in the epinephrine group, whereas, postoperatively, the plasma levels of both catecholamines were highest in the patients receiving general anesthesia. The latter patients experienced significantly more nausea and vomiting than the regional anesthesia groups. Patients with regional anesthesia required significantly less analgesics postoperatively than the patients receiving general anesthesia.
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Regional anesthesia · Jan 1991
Anatomic spread of india ink in the human intercostal space with radiographic correlation.
In a study designed to determine the spread of anesthetic solutions in the intercostal space, the spread of india ink was studied in fresh cadavers. They were turned prone and had epidural catheters placed at ribs 4, 6, 8 and 10, 7-8 cm lateral to the midline, by two different techniques. Group 1 had epidural catheters directed laterally into the subcostal groove. ⋯ Posteroanterior and lateral radiographs taken with contrast material in live patients confirmed these patterns of spread. The catheters in Groups 1 and 2 were within the same tissue plane. The results indicate that the pattern of spread obtained by injection of fluid in the intercostal space is dependent upon the site of injection in relation to the angle of the rib.
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Epidural abscess is a neurologic emergency. Diagnosis may be difficult and costly to patients and health care providers in terms of time and money expended. ⋯ Diagnostic studies were performed that documented the presence of a spinal epidural abscess. Routine aspiration of an implanted epidural catheter facilitated the early diagnosis of epidural abscess in our patient prior to the performance of these studies.