Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous regional anesthesia with meperidine.
Forty-five ASA physical status I volunteers, divided in three groups of 15 each, received intravenous regional anesthesia (IVRA) of the upper limb with 40 mL meperidine 0.25%, lidocaine 0.5%, or 0.9% sodium chloride (isolated ischemia) by random allocation. Using a double-blind method, the onset and recovery of sensory block was tested at six sites of the forearm and hand. The onset of complete motor block was also assessed. ⋯ In the meperidine group, motor block developed concomitantly or prior to sensory block. There was a significant increase in the incidence of dizziness, nausea, and pain at the injection site in the meperidine group in comparison with the lidocaine group. We conclude that meperidine has local anesthetic action on the peripheral nerve in vivo, but that its single use for IVRA should be a second choice for patients allergic to local anesthetics.
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Anesthesia and analgesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe addition of epinephrine enhances postoperative analgesia by intrathecal morphine.
To investigate whether the addition of epinephrine would enhance postoperative pain relief by intrathecal morphine, we studied 36 patients scheduled to have spinal anesthesia for gynecologic surgery. Patients were randomly allocated to one of three groups: the first received epinephrine 0.12 mg, morphine 0.2 mg, and hyperbaric tetracaine 12 mg intrathecally (EMT group, n = 11); the second received morphine 0.2 mg and hyperbaric tetracaine 12 mg intrathecally (MT group, n = 13); and the third received epinephrine 0.12 mg and hyperbaric tetracaine 12 mg intrathecally (ET group, n = 12). The time to the first request for supplemental analgesics was longest (2182 +/- 251 min, mean +/- SEM) and the injection number of supplemental analgesics was least in the EMT group (P < 0.05). ⋯ The visual analog scale (VAS) pain score was larger in the ET group than the EMT group (P < 0.05), but was similar in the EMT and MT groups. There were no differences among groups in the incidence of nausea and pruritus. Our data show that the addition of epinephrine enhances postoperative analgesia by intrathecal morphine without increasing the incidence of adverse effects as compared with intrathecal morphine alone.
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Anesthesia and analgesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialRenal function and serum fluoride concentrations in patients with stable renal insufficiency after anesthesia with sevoflurane or enflurane.
Sevoflurane is metabolized to hexa-fluoro-isopropanol and inorganic fluoride by the human liver. Its use as an anesthetic may lead to peak plasma fluoride concentrations exceeding those seen after enflurane. Although there is no nephrotoxicity after sevoflurane anesthesia in humans with normal kidneys, those with chronically impaired renal function might be at increased risk because of increased fluoride load due to prolonged elimination half-life. ⋯ No patient suffered a permanent deterioration of preexisting renal insufficiency and none required dialysis. Thus, neither sevoflurane nor enflurane deteriorated postoperative renal function in these patients with preexisting renal insufficiency. There is no evidence that fluoride released by metabolism of sevoflurane metabolism worsened renal function in these patients with stable, permanent serum creatinine concentrations more than 1.5 mg/dL.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia after bilateral myringotomy and placement of pressure equalization tubes in children: acetaminophen versus acetaminophen with codeine.
Despite the brief nature of the procedure with limited tissue trauma, some form of analgesia is required in most children after bilateral myringotomy and placement of pressure equalization (PE) tubes. Previous studies have demonstrated the relative inefficacy of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs), with 30%-55% of patients requiring supplemental postoperative analgesia. We undertook a prospective study evaluating the efficacy of the preoperative administration of oral acetaminophen (15 mg/kg) versus acetaminophen (10 mg/kg) and codeine (1 mg/kg). ⋯ None of the 25 patients who received acetaminophen with codeine required supplemental analgesics compared with 12 of 25 who received acetaminophen. No adverse effects were noted in either group. We conclude that the preoperative administration of acetaminophen with codeine provides superior analgesia after bilateral myringotomy and placement of PE tubes.
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Anesthesia and analgesia · Sep 1995
Comparative StudyComparison of needle deviation during regional anesthetic techniques in a laboratory model.
Although many characteristics of needles used for spinal and epidural anesthesia have been studied extensively, the amount that a needle deviates from a straight path while passing through tissue has been relatively ignored. A laboratory model was used to determine the amount of needle deviation produced when different types of new spinal needles and epidural needles were passed through porcine tissue. ⋯ Needles commonly used for epidural anesthesia (Tuohy, Hustead, Crawford) exhibited increased deviation (range 1.73-3.54 mm/50 mm tissue), although the largest amount was seen with beveled spinal needles (Quincke, Atraucan) (range 4.42-5.90 mm/50 mm tissue). The possible clinical significance of needle deviation during the performance of a regional anesthetic is discussed.