Articles: anesthetics.
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Low back pain and sciatica have been treated with peridural local anesthetics for over 80 years and with epidural and subarachnoid steroid injections for a quarter of a century. This review surveyed the literature concerning the evolution, pathophysiology, complications and results of this type of therapy. The volume injected and the method used vary with different physicians and no standard has been established. ⋯ It is the authors' opinion that the rationale for the use of spinal local analgesics or steroids or intramuscular steroids has not been scientifically proven. Complications with the use of subarachnoid steroids are sufficiently serious that this form of therapy should be condemned. In this age of accountability it is imperative that therapies with questionable benefits should be critically evaluated.
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Anesthesia and analgesia · May 1985
Acid and alkaline solutions of local anesthetics: duration of nerve block and tissue pH.
The effect of solution pH on the duration of rat infraorbital nerve blocks produced by 1% lidocaine or 0.25% bupivacaine at pH 5.0 and 7.4, with and without epinephrine was investigated in a double-blind study. The time course of tissue pH changes subsequent to infections into the infraorbital area or abdominal musculature of rats was measured with a tissue pH microelectrode. Injectable pH had little or no effect upon the duration of block. Tissue pH was minimally changed by the injection of solutions at pH 7.4, but decreased appreciably with injections of solutions at pH 5.0, or if the injectate contained epinephrine.
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Acta Anaesthesiol Scand · Apr 1985
Randomized Controlled Trial Comparative Study Clinical TrialIsoflurane v fentanyl for outpatient laparoscopy.
Isoflurane and fentanyl have been compared as anaesthetic agents for outpatient laparoscopy. In 50 female patients anaesthesia was induced with thiopentone and maintained with nitrous oxide 66% in oxygen combined with either isoflurane 1-2% or fentanyl 0.3 mg according to a randomized list. Suxamethonium was used to facilitate intubation and for further muscle relaxation. ⋯ Reaction times in the isoflurane patients returned to control by 3 h, whereas the fentanyl patients were 10% slower than control at 4 h (P less than 0.05 at 2 h, 3 h, 4 h). Nausea and vomiting were more frequent in the fentanyl group, and four of the fentanyl patients required naloxone. Both anaesthetic techniques provided satisfactory operating conditions, but isoflurane appeared to provide a better recovery with less side effects than fentanyl.
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Randomized Controlled Trial Clinical Trial
Effects of the extradural administration of local anaesthetic agents and morphine on the urinary excretion of cortisol, catecholamines and nitrogen following abdominal surgery.
Twenty patients undergoing major abdominal surgery were allocated randomly to receive either general anaesthesia with low-dose fentanyl plus intermittent systemic morphine for postoperative pain or the same general anaesthetic plus extradural analgesia during and following surgery (local anaesthetics from before skin incision until 24 h after skin incision plus extradural morphine 4 mg every 12 h from 3 h to 72 h after skin incision). Postoperative pain scores were lower (P less than 0.05) in the group receiving extradural analgesia, but this regimen failed to prevent the increase in the urinary excretion of cortisol, adrenaline, noradrenaline and nitrogen both on separate days and on cumulative measurements over 4 days. Pain scores did not correlate to urinary excretion of the various endocrine-metabolic indices either on separate days or over the cumulative 4-day period. It is concluded that the relief of pain per se has no major influence on the catabolic response to abdominal surgery.