Anesthesia and analgesia
-
Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialLocal analgesia without anesthesia using peripheral perineural morphine injections.
Twenty-five patients with chronic pain were treated with nerve blocks. They were divided into two groups, A and B, according to the volume of local anesthetic required for surgical anesthesia by standard nerve block techniques. The 16 patients in group A had pain in the distribution of small nerves, which could be blocked with 5 ml or less. ⋯ Morphine (6 mg) was added, in a random, double-blind fashion, to one of the injections. A second pair of injections was subsequently done, using morphine by the alternative route. Perineural morphine provided statistically longer lasting pain relief than did either intramuscular morphine or perineural bupivacaine.
-
Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialProlongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly.
The effects of vasoconstrictors on the duration of isobaric bupivacaine spinal anesthesia are unknown. A prospective controlled study was conducted on 60 ASA class II or III patients aged 75 yr or more who were scheduled for spinal anesthesia for orthopedic hip surgery. The subjects were randomly allocated into three groups. ⋯ Mean time for regression to the L2 segment was also significantly longer in groups II and III than in group I. This time tended to increase more with the bupivacaine plus clonidine solution than with the bupivacaine plus epinephrine solution. Significant prolongation of motor block was also associated with the addition of clonidine.
-
Anesthesia and analgesia · May 1987
Comparative StudyPrior carotid surgery does not affect the reliability of landmarks for location of the internal jugular vein.
Twenty-one volunteer subjects who had undergone prior carotid endarterectomy (CEA) agreed to an ultrasound study of the neck. The transducer was held as one would hold a cannulating needle and ultrasound images were obtained of the great vessels in the neck. Each of two cannulating techniques was simulated on each side of every patient's neck. ⋯ These data show that prior CEA does not affect the location of the IJV. Tissue alterations or adhesions may render actual IJV cannulation more difficult or risky. The data suggest but do not prove that prior CEA may not increase the incidence of CA puncture under clinical conditions.
-
Anesthesia and analgesia · May 1987
Comparative StudyPlasma concentrations of epidural bupivacaine in mother and newborn: 0.125% versus 0.375%.
Central venous plasma concentrations of bupivacaine were determined in two groups of 15 parturients each who were given epidural analgesia for labor and vaginal delivery. One group received 10 ml of 0.125% bupivacaine plus epinephrine 1:800,000, the other group received 7 ml of 0.375% bupivacaine plus epinephrine 1:800,000. Plasma concentrations of bupivacaine in the umbilical venous (UV) and the umbilical arterial (UA) blood of their babies were also determined. ⋯ The measured plasma concentrations speak in favor of the less concentrated solution of bupivacaine in epidural analgesia for obstetrics. Seven milliliters of bupivacaine 0.375% is suitable for epidural analgesia in obstetrics but a low concentration-low dose technique, using 10 ml of bupivacaine 0.125% plus epinephrine 1:800,000 is safer. It provides good analgesia with minimal or no motor block and is associated with low maternal and neonatal plasma concentrations of bupivacaine, well below toxic levels and, to our knowledge, lower than in any other study.