Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1989
Randomized Controlled Trial Clinical TrialEpidural hydromorphone with and without epinephrine for post-operative analgesia after cesarean delivery.
The efficacy of epidural hydromorphone alone or in combination with epinephrine for postoperative analgesia was evaluated in 30 healthy women who underwent cesarean delivery with epidural anesthesia. They were assigned randomly to receive either 1.5 mg hydromorphone alone (N = 15) or 1.5 mg hydromorphone with 1/200,000 epinephrine (N = 15). Duration of analgesia (mean +/- SD) was 24.3 +/- 9.4 hours after the epidural injection of hydromorphone plus epinephrine. ⋯ Side effects including pruritus (73%), nausea (20%), and vomiting (15%) were of similar frequency with and without epinephrine. Although mean venous PCO2 (PvCO2) levels three and six hours after the hydromorphone-epinephrine dose were elevated significantly over the pre-drug PvCO2 levels, no respiratory depression was detected by an apnea monitor to which all patients were connected. The addition of epinephrine to epidural hydromorphone hastened onset and prolonged the duration of analgesia after cesarean section.
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Anesthesia and analgesia · Mar 1989
Randomized Controlled Trial Clinical TrialEpidural butorphanol-bupivacaine for analgesia during labor and delivery.
A double-blind, randomized, dose-response study of a combination of 0.25% bupivacaine combined with 0, 1, 2, or 3 mg of butorphanol was studied in 40 laboring parturients. The optimal dose of butorphanol combined with 8.5 to 10 ml 0.25% bupivacaine was 2 mg; with 2 mg, the duration of analgesia was significantly greater and the time to onset of analgesia significantly shorter than when no butorphanol was added, and the amount of bupivacaine could be reduced 50%. ⋯ All neonatal observations were normal. It is concluded that epidural butorphanol can be a useful and safe adjunct to bupivacaine used for epidural analgesia during labor.
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Anesthesia and analgesia · Mar 1989
Dose-response relation and time course of action of pipecuronium bromide in humans anesthetized with nitrous oxide and isoflurane, halothane, or droperidol and fentanyl.
The dose-response of pipecuronium bromide, the time course of its neuromuscular blocking effects, and the reversibility of the residual block by neostigmine and edrophonium have been investigated in patients undergoing various types of anesthesia. The estimated doses of pipecuronium required for 95% depression of the twitch height were 44.6, 46.9, and 48.7 micrograms.kg-1 during anesthesia with nitrous oxide (65%) and isoflurane (group 1), halothane (group 2), or droperidol/fentanyl (group 3), respectively. ⋯ Both edrophonium chloride (0.5 mg.kg-1) and neostigmine methylsulphate (40 micrograms.kg-1) promptly reversed the residual block induced by pipecuronium. No side effects attributable to pipecuronium were seen in this study.
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Anesthesia and analgesia · Mar 1989
Comparative Study Clinical Trial Controlled Clinical TrialSurgical repair of hip fractures using continuous spinal anesthesia: comparison of hypobaric solutions of tetracaine and bupivacaine.
The aim of this study was to compare hypobaric solutions of tetracaine and bupivacaine in 30 geriatric patients undergoing surgical repair of hip fractures while under continuous spinal anesthesia. Tetracaine 1% and bupivacaine 0.5% were mixed with distilled water to prepare hypobaric 0.25% solutions. In a double-blind fashion, all patients received 3 ml (7.5 mg) of either solution in the lateral decubitus position with the operated side up, the table being kept horizontal for 30 minutes after injection. ⋯ In both groups, motor blockade was satisfactory in 29/30 patients on the operated side. The frequency of a decrease in systolic blood pressure of more than 30% was similar in the two groups. The authors conclude that hypobaric solutions of both tetracaine and bupivacaine are suitable for surgical repair of hip fractures in geriatric patients and produce comparable anesthetic and hemodynamic effects.
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Anesthesia and analgesia · Mar 1989
Comparative StudyExtent of blockade with various approaches to the lumbar plexus.
The extent of blockade when four different techniques were used for blocking the lumbar plexus was prospectively evaluated in 80 adult patients. The extent of blockade was measured by testing motor function of all nerves except the lateral and posterior femoral cutaneous nerves, which were evaluated by pinprick response. ⋯ None of the four techniques produced blockade of the sacral plexus. Perhaps our means of assessing blockade (motor) is what produced the difference between our findings and those of others.