Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1980
Randomized Controlled Trial Comparative Study Clinical TrialSpinal anesthesia: bupivacaine compared with tetracaine.
A solution of 0.75% bupivacaine (Marcaine) in 8.25% dextrose was compared with a similar solution of tetracaine (Pontocaine), the drug most used for spinal anesthesia in the USA. The study employed a randomized double-blind method and a standardized technique for spinal anesthesia in 435 patients. For perineal and lower extremity surgery, 7.5 mg of the local anesthetic was injected, and for intra-abdominal gynecologic surgery, 12 mg was administered. ⋯ Epinephrine added to the local anesthetic solution significantly increased the duration of action of both drugs. It also prolonged the duration of postoperative analgesia of tetracaine significantly more than the duration of bupivacaine. Bupivacaine 0.75% in 8.25% dextrose is a safe, reliable local anesthetic solution for spinal anesthesia.
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The incidence of headache after dural puncture in patients being treated for chronic pain was studied prospectively. Dural punctures were performed in 142 patients and headache developed in 13 (9.2%). Four of 32 patients (12.5%) who underwent diagnostic differential spinal and nine of 110 patients (8.2%) given intrathecal steroid injection developed headache. ⋯ The incidence decreased with increasing age. The incidence of postdural puncture headache in chronic pain patients does not differ significantly from that previously reported for surgical patients. All patients who developed headache responded to treatment which consisted of intravenous and oral fluids, analgesics, bed rest, and, if necessary, epidural blood patch.
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Anesthesia and analgesia · Oct 1980
Age and the spread of local anesthetic solutions in the epidural space.
Sensory level of anesthesia following the injection of 20 ml of 1.5% lidocaine with epinephrine (1:200,000) in 238 adult males averaged T7.7, T5.6, and T5.1 at 10, 20, and 30 minutes, respectively. Patient age had no significant effect on local anesthetic requirements per spinal segment per unit height until age 40 years, which age the calculated amount of local anesthetic decreased significantly to 0.62 ml from 0.69 ml/segment/meter of height. ⋯ Patient height was inversely related to sensory level (p < 0.001). Time required for anesthesia ro recede to T12 averaged 164 minutes and was slightly but significantly (p < 0.05) prolonged with advancing age.