Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intercostal nerve block for lumpectomy: superior postoperative pain relief with bupivacaine.
To investigate whether equipotent doses of lidocaine and bupivacaine were equally effective for intercoastal nerve blockade (ICNB) and whether a lower amount of lidocaine would be comparably effective. To see whether plasma levels of lidocaine with and without epinephrine and of plain bupivacaine would reach toxic ranges. Finally, to evaluate the duration of postoperative analgesia following general anesthesia and regional anesthesia with two different local anesthetics. ⋯ ICNB is an alternative to general anesthesia for female breast surgery. Both lidocaine with epinephrine and plain bupivacaine in the doses used did not raise venous plasma concentrations to levels considered potentially toxic. With respect to duration of postoperative pain relief and analgesic drug request, the local anesthetics (in particular, bupivacaine) were found to be superior to general anesthesia.
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Randomized Controlled Trial Clinical Trial
Intravenous ketorolac as an adjunct to patient-controlled analgesia (PCA) for management of postgynecologic surgical pain.
To determine whether intravenous (IV) doses of ketorolac tromethamine provide safe and effective augmentation of postsurgical analgesia for patients using IV patient-controlled analgesia (PCA) with morphine. ⋯ IV ketorolac used as an analgesic adjunct provided safe and effective augmentation of PCA with morphine in patients recovering from intra-abdominal gynecologic surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
The frequency of postdural puncture headache in obstetric patients: a prospective study comparing the 24-gauge versus the 22-gauge Sprotte needle.
To compare the frequency of postdural puncture headache (PDPH) in obstetric patients when using the 24-gauge or the larger 22-gauge Sprotte needle. ⋯ Our results suggest that the 22-gauge Sprotte needle, when compared with the smaller 24-gauge Sprotte needle, can be used in obstetric patients without increasing the frequency of PDPH.
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For the patient scheduled for head and neck cancer surgery, careful assessment of the airway demonstrates the most appropriate course of action for securing the airway before surgery begins. Often the patient may be anesthetized safely before intubation of the trachea. The patient may require an awake examination of the airway under sedation and topical analgesia or an awake fiberoptic intubation before the induction of general anesthesia. ⋯ After the operation, extubation of the trachea requires careful attention and may be even more of a challenge than the original intubation. Current principles and techniques for the anesthetic management of the patient undergoing head and neck cancer surgery are reviewed. Emphasis is placed on avoiding the airway problems associated with this kind of surgery.
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Comparative Study
Vecuronium neuromuscular blockade at the cricothyroid and posterior cricoarytenoid muscles of the larynx and at the adductor pollicis muscle in humans.
To compare the sensitivity to vecuronium in the cricothyroid (CT) and posterior cricoarytenoid (PCA) muscles of the larynx and the adductor pollicis muscles. ⋯ The laryngeal (CT and PCA) muscles are more resistant to vecuronium than is the adductor pollicis, and the PCA muscle is more resistant to vecuronium than is the CT muscle. This finding suggests that partially paralyzed patients are able to maintain laryngeal patency despite the apparent impaired neuromuscular transmission in the adductor pollicis muscle.