Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 1998
Randomized Controlled Trial Clinical TrialDifferential effect on vasodilatation and pain after intradermal capsaicin in humans during decay of intravenous regional anesthesia with mepivacaine.
When given intracutaneously, capsaicin can cause burning pain by central propagation in thin afferents, as well as neurogenic vasodilatation, reflecting antidromic conduction in the same fibers. We wanted to test the hypothesis that an intravenous regional block (IVRA) inhibits these two phenomena to a similar degree. ⋯ Mepivacaine, given as an IVRA, had no effect on the post-IVRA sensory function of thin afferents but differentially decreased the spread of the capsaicin-induced flare.
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Reg Anesth Pain Med · Jul 1998
Randomized Controlled Trial Comparative Study Clinical TrialThermoregulatory effects of spinal and epidural anesthesia during cesarean delivery.
Hypothermia is likely to develop faster during spinal anesthesia than epidural anesthesia. A natural consequence of the rapid temperature decrease during spinal anesthesia is that the shivering threshold will be reached sooner and that more shivering will be required to prevent further hypothermia. We tested the hypotheses that the onset of hypothermia is more rapid and the onset and intensity of shivering earlier during spinal than epidural anesthesia. ⋯ We failed to confirm our hypothesis, but for an unexpected reason: Thermoregulation was impaired more by spinal anesthesia than epidural anesthesia. It seems likely that in our patients spinal anesthesia inhibited thermoregulatory control more than epidural anesthesia because it better blocked sensory input from the legs.
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Reg Anesth Pain Med · Jul 1998
Randomized Controlled Trial Comparative Study Clinical TrialA clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia.
The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. ⋯ The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.
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Reg Anesth Pain Med · Jul 1998
Case ReportsUnusually prolonged duration of spinal anesthesia following 2% mepivacaine.
Spinal mepivacaine has been reported as a reliable anesthetic for ambulatory anesthesia. Its pharmacologic properties are midway between those of bupivacaine and lidocaine, and it can be used in intermediate duration ambulatory surgical procedures. ⋯ Clonidine can increase the duration of spinal anesthetics. Even though this well-known effect has been considered mostly beneficial, it can be an adverse effect when spinal ambulatory anesthesia is given to patients receiving clonidine TTS or clonidine in other forms for long-term treatment of hypertension or other diseases.