Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Clinical TrialEvaluation of peripheral morphine analgesia for lumpectomy and axillary node dissection: a randomized, double-blind, placebo-controlled study.
Morphine may elicit potent antinociceptive effects by binding and activating peripheral opioid receptors. However, the results in clinical studies have varied. We examined the postoperative analgesic effects of incisional morphine in patients undergoing lumpectomies and axillary node dissections for breast cancer. For this purpose, a concentration of morphine within the range (0.25-0.6%) of those utilized in previous studies for postarthroscopy analgesia was chosen (0.6%). ⋯ These results suggest that under the conditions of the study protocol, there is no value in utilizing morphine in solution at the surgical site for postoperative lumpectomy and axillary node dissection analgesia.
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Reg Anesth Pain Med · Mar 1999
The safety and efficacy of combined spinal and epidural analgesia/anesthesia (6,002 blocks) in a community hospital.
This study examined the safety and efficacy of combined spinal and epidural (CSE) analgesia/anesthesia performed in a community hospital. ⋯ This review of 6,002 CSE blocks performed in a community hospital has demonstrated that CSE labor analgesia, surgical anesthesia are safe and efficacious. We believe that patient observation and continuous pulse oximetry for 1-2 hours after administration of ITS and prompt treatment with intravenous naloxone for severe drowsiness, low oxygen saturation (PaO2 < 90% unresponsive to mask oxygen), or dysphagia should be used to minimize the risk of apnea.
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Clinical TrialThe effect of anesthetic patient education on preoperative patient anxiety.
Preoperative time spent with patients has been abbreviated with the advent of same-day admission requirements and outpatient surgery. This study was conducted to evaluate the effects that materials mailed to the home relating to anesthetic-focused patient education may have on preoperative patient anxiety. ⋯ Increase in preoperative anxiety is diminished when additional anesthesia information in printed and video format is made available. Useful information can be provided to patients to view or read prior to surgery.
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Clinical TrialThe association between injected volume of local anesthetic and spread of epidural anesthesia: a hypothesis.
Clinically, an increase of the injected volume of local anesthetic does not result in a linear increase in the spread of epidural anesthesia. This study was designed to evaluate this observation. ⋯ The present study demonstrates lack of a linear relationship between injected volume of local anesthetic and spread of epidural anesthesia. Whether the cubic equation developed is clinically useful remains unclear because of the variability of the data.
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialContinuous spinal anesthesia: a comparative study of standard microcatheter and Spinocath.
This prospective, randomized study evaluated the advantages and disadvantages of a new subarachnoid catheter. ⋯ Spinocath insertion required 6.3 +/- 3.2 minutes in group 1 versus 3.9 +/- 1.2 minutes in group 2 (P < .01) with similar difficulties with catheter introduction. Perception of dural puncture was better in group 1 (P < .05). There were significant intergroup differences in time to free flow of CSF through the catheter. In group 2, correct catheter positioning had to be confirmed by aspiration in 80% of cases (P < .05). At the end of surgery, the catheters were removed, and there were no significant differences between groups. The anesthetic blocks were similar with both systems. Patient opinion of the technique did not differ between groups, and regression analysis did not show any differences between groups or correlation to any incident during performance of the technique. Globally, the anesthesiologists participating in the study considered both systems to be easy to use and adequate for continuous spinal anesthesia. With respect to the advantage afforded by a directional needle in orientating the catheter within the spinal canal, the Spinocath system-with a longer technique performance time than the standard approach-involves a success rate and incidence of technical problems similar to that of the conventional technique.