British journal of anaesthesia
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Comparative Study
Intercostal nerve block for postoperative somatic pain following surgery of thorax and upper abdomen.
From 1948 to 1973, intercostal nerve block was used 10,941 times or a total of approximately 100,000 individual nerves were blocked. Junior staff (residents) performed 95% of the blocks. The local anaesthetic solution of choice used 0.25 or 0.5% bupivacaine (Marcaine) with adrenaline. ⋯ The duration of the blocks was 9-18 hr. No severe systemic toxic reactions occurred, e.g. disorientation, convulsions, etc. The incidence of pneumothorax was 0.073%.
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Comparative Study
Evaluation of clinical tolerance of local anaesthetic agents.
The clinical tolerance to local anaesthetic drugs can be assessed from a knowledge of their pharmacokinetic behaviour, their absorption properties and the effects produced by controlled i.v. infusions. Pharmacokinetic behavior can be calculated from the plasma concentrations of the drugs injected i.v. in non-toxic doses. Absorption properties can likewise be determined from plasma concentrations following injection at various sites. ⋯ Such dosage is considerably affected by the rate of injection. The venous plasma concentrations at the height of toxicity are unreliable guides to toxicity. Experiences using the new local anaesthetic etidocaine are reported.
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Information derived from measurements of blood concentrations of local anaesthetics can be extended by the application of pharmacokinetic anaylsis. A better understanding of quantitative aspects of the disposition and absorption of these drugs should assist the anaesthetist in deciding the optimal agent and dosage for regional block techniques.
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Experiments are described which demonstrate that dantrolene sodium effectively terminates the syndrome of malignant hyperpyrexia induced in susceptible swine by exposure to halothane. Dantrolene is also shown to block initiation of the syndrome of malignant hyperpyrexia by halothane in MHS swine. Therapeutic use of this drug in patients with anaesthetic-induced malignant hyperpyrexia appears to be indicated.