Articles: analgesia.
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Loss of sensation to pinprick and cold are commonly used to test the extent of epidural anesthesia. To see what difference exists between the level of epidural block determined by various sensory modalities, we performed this study in ten volunteers using epidural anesthesia with plain 3% chloroprocaine hydrochloride. ⋯ This study establishes the existence of a differential epidural anesthesia during high thoracic block with chloroprocaine and suggests that the intensity of block diminishes as distance from site of injection increases.
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Cahiers d'anesthésiologie · Jan 1992
Review[Fetal and neonatal effects of perimedullary opioids used in obstetrical anesthesia].
The use of spinal or epidural narcotics is more and more frequent in obstetric patients since it enhances the analgesia induced by local anesthetics. However, specific information regarding their fetal and neonatal effects is rare. Fetal effects are mainly dependent on the respiratory and hemodynamic maternal effects, and thus usually limited when usual low dosages of intraspinal narcotics are used. ⋯ In contrast, the evaluation of Apgar and neurobehavioral scores, performed for all the narcotics used, shows little changes when low dosages are used. However, the use of larger dosages epidurally is associated with an increased frequency of low neurobehavioral scores. Therefore, the use of low dosages of epidural narcotics is recommended since there is little available information about the risk of neonatal respiratory depression and no clear maternal advantage of higher dosages.
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Regional anesthesia · Jan 1992
Continuous epidural methadone for the management of postoperative pain after lower abdominal surgery.
The efficacy of methadone administered by continuous epidural infusion for 24 hours for the management of postoperative pain has been reported. The pharmacokinetic characteristics of methadone predict that significant accumulation would occur if infusions were continued for longer than 24 hours and that this accumulation could result in serum concentrations above the threshold associated with systemic analgesia. ⋯ The accumulation of serum concentrations reported here argue that the risks of thoracic epidural placement may outweigh the potential benefits when methadone is administered alone by continuous infusion for longer than 24 hours.