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 · Sep 1989
Case ReportsGuillain-Barre syndrome after obstetrical epidural analgesia.
Guillain Barre Syndrome (GBS) occurred 24 hours post-partum following an obstetrical epidural anesthetic (OEA) procedure. Clinical diagnosis was confirmed by cerebrospinal fluid (CSF) findings and nerve conduction velocity studies. GBS is an immune mediated process. Because of short latency between the onset of symptoms and the performance of the epidural block, a cause and effect relationship between epidural block and GBS in this patient is unlikely.
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Regional anesthesia · Sep 1989
The subjective complications and efficiency of the epidural blood patch in the treatment of postdural puncture headache.
The complications and efficacy of epidural blood patch were studied retrospectively by means of a questionnaire sent to 236 patients. Hospital records were also studied. ⋯ Epidural blood patch was found to be effective; 84.5% of the respondents had complete and permanent recovery from headache in less than 24 hours after a single epidural blood patch. Of those responding, 42.3% were willing to undergo spinal anesthesia in the future, when indicated, only if they could be assured of getting epidural blood patch in the event of a postdural puncture headache.
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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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Six groups of ten women each in active labor at term had epidural catheters placed in the usual manner and received a 3 mL test dose of 2% lidocaine with epinephrine. Groups 1-6 received, respectively, 5, 10, 20, 30, 40 and 50 micrograms of sufentanil diluted to 10 mL with normal saline. Significantly effective analgesia was provided at all sufentanil doses studied, with pain scores decreasing from 8.1 +/- 0.2 at baseline to 2.9 +/- 0.3 at 10 minutes and 1.1 +/- 0.2 at 30 minutes (mean +/- SEM, average for all groups). ⋯ There were no serious maternal side effects, although ten patients developed pruritus, four became dizzy, two experienced mild sedation, and one had transient hypotension. No neonatal side effects occurred. Maternal serum sufentanil levels remained below the sensitivity of the assay, or 0.1 ng/ml.