Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1994
[Combined epidural and spinal anesthesia for cesarean section].
Combined spinal epidural block has proven its efficacy in skilled hands. This technique allies advantages of spinal anaesthesia, regarding its speed of action and intensity of motor blockade and advantages of postoperative epidural analgesia. ⋯ Local anaesthetics and additives are reviewed and commented. The two main complications, hypotension and post dural puncture headache can be contained in very low limits.
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Cahiers d'anesthésiologie · Jan 1994
[Mechanisms of the analgesic effect of alpha 2 adrenergic agonists].
Alpha 2 adrenergic agonists stimulate specific receptors in the dorsal horn of the spinal cord leading to blockade of potassium and calcium channels. Presynaptic alpha 2 receptors inhibit the release of substance P and other neuropeptides which stimulate transmission of nociceptive stimulations. Post-synaptic alpha 2 receptors hyperpolarize neurons membranes and decrease the activity of nociceptive neurons. In addition, alpha 2 adrenergic agonists have a synergistic action with opioid and cholinergic agonists.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Effect of epidural analgesia on obstetrical mechanics].
Epidural analgesia is the most effective technique of pain relief during labour. However, there is an old suspicion that it modifies the course of labour. ⋯ The deleterious effect on the second stage is primarily due to motor blockade of the pelvic floor muscles which normally exert an important influence on fetal accommodation. It is possible to limit the negative effect of motor blockade by using either a combination of low-dose bupivacaine and opioid, or injection of a lipophilic opioid through a subarachnoid catheter, or by using the new amide local anaesthetic, ropivacaine, which is claimed to possess less motor blocking action.
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Sciatic nerve blocks were seldom used until recently. They apply to most surgical procedures on the lower limb and are often combined with a "3 in 1" block. ⋯ Sciatic nerve block can be obtained by different techniques. The choice of which being helped by some guidelines according to the patients characteristics and the surgical site.