Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1992
Randomized Controlled Trial Clinical TrialAlkalinization of mepivacaine for axillary block.
We examined the onset and distribution of sensory blockade, the onset of motor blockade, and venous mepivacaine concentrations after axillary block with 1.25% mepivacaine with and without bicarbonate. There were no statistically significant differences between the alkalinized and placebo groups with respect to distribution of analgesia or anesthesia, time to onset of analgesia, or time to onset of paresis. ⋯ Concentrations of mepivacaine in venous blood did not differ significantly. We conclude that alkalinized mepivacaine offers the advantage of quicker onset of more profound blockade in several terminal nerve distributions.
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Anesthesia and analgesia · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialUse of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration.
Fentanyl, unlike morphine, is highly lipophilic and rapidly diffuses out of the epidural space. Respiratory depression is, therefore, unlikely when fentanyl is given epidurally. However, much of fentanyl's analgesic effect is mediated by systemic rather than spinal receptor binding. ⋯ There were also no significant differences in the cumulative dosage of fentanyl within each group (epidural vs IV) or between the groups. Thus, the analgesic effects of epidural fentanyl appear largely mediated by systemic absorption. Intravenous fentanyl achieves a similar degree of analgesia and a more rapid onset of effect without the need for epidural catheterization.