Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1998
Randomized Controlled Trial Comparative Study Clinical Trial0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patient-controlled epidural infusion.
We compared the effects of 0.125% ropivacaine with 0.125% bupivacaine in laboring patients using patient-controlled epidural analgesia (PCEA). Fifty-one ASA physical status I or II term parturients with functioning epidural catheters were randomized to receive ropivacaine or bupivacaine using a prospective, double-blind design. Basal infusions (6 mL/h) were supplemented with patient-controlled boluses (5 mL) every 10 min as required. For inadequate analgesia, patients were administered 10-mL boluses of study solution until comfortable. There were no differences in verbal pain scores, amount of local anesthetics used, sensory levels, motor blockade, labor duration, mode of delivery, side effects, or patient satisfaction between the two local anesthetics. We conclude that 0.125% ropivacaine and bupivacaine are clinically indistinguishable and are both highly effective for labor analgesia using PCEA. ⋯ This study compared labor analgesia from 0.125% ropivacaine and 0.125% bupivacaine using patient-controlled epidural analgesia. We found no significant differences in local anesthetic use, analgesic characteristics, or side effects between 0.125% ropivacaine and 0.125% bupivacaine. We conclude that these two drugs are clinically indistinguishable at this concentration.
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Anesthesia and analgesia · Mar 1998
Randomized Controlled Trial Clinical TrialAlkalinization of lidocaine does not hasten the onset of axillary brachial plexus block.
We assessed the onset of sensory and motor blockade as well as the distribution of sensory blockade after axillary brachial plexus block with 1.5% lidocaine hydrochloride 1:200,000 epinephrine with and without sodium bicarbonate in 38 patients. The onset of analgesia and anesthesia was recorded over the distributions of the median, ulnar, radial, and medial cutaneous nerves of the forearm, medial cutaneous and lateral cutaneous nerves of the arm, and musculocutaneous nerve. The onset of motor blockade of elbow and wrist movements was also recorded. Data were analyzed by using survival techniques and compared by using log rank tests. Only the onset of analgesia in the medial cutaneous nerves of the arm and forearm, and the onset of anesthesia in the medial cutaneous nerve of the arm were significantly faster (P < 0.05) with alkalinization of lidocaine. Our study showed that alkalinization of lidocaine does not significantly hasten block onset in most terminal nerve distributions. ⋯ We examined whether alkalinizing a local anesthetic would quicken the onset of a regional upper limb nerve blockade. We found that alkalinization of lidocaine did not offer a significant clinical advantage in axillary brachial plexus blockade.
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Anesthesia and analgesia · Mar 1998
Randomized Controlled Trial Comparative Study Clinical TrialAn in vivo evaluation of four spinal needles used for the combined spinal-epidural technique.
The purpose of this study was to evaluate four pencil-point spinal needles commonly used for combined spinal-epidural (CSE) anesthesia. Four hundred-seven consecutive parturients undergoing cesarean delivery or labor analgesia received a CSE block with a randomly selected pencil-point spinal needle (Becton-Dickinson [B-D] 27-gauge, 119-mm Whitacre; B-D 27-gauge, 120-mm Durasafe; B-D 25-gauge, 120-mm Durasafe; or International Medical Devices' 26-gauge, 124-mm Gertie Marx). Success in obtaining cerebrospinal fluid (CSF) and the incidence of transient paresthesias and postdural puncture headache (PDPH) were compared by using chi2 testing; P < 0.05 was considered significant. Failure to obtain CSF (3%-5%) was not significantly different among spinal needles. The Gertie Marx 26-gauge needle was associated with significantly more paresthesias (29%) than the Whitacre 27-gauge needle (17%). The combined incidence of paresthesias with the Durasafe 25-gauge and Gertie Marx 26-gauge spinal needles (28%) was greater than the combined incidence of paresthesias with the Durasafe 27-gauge and Whitacre 27-gauge needles (18%). The incidence of PDPH did not differ among the four pencil-point spinal needles. We conclude that longer spinal needles are associated with a significantly more frequent incidence of transient paresthesias without residual effects. ⋯ The use of four pencil-point spinal needles in the combined spinal-epidural technique is associated with an inconsequential incidence of spinal headache, a low incidence of paresthesias that are transient with no long-term effects, and a high degree of success independent of spinal needle length.