Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 1999
ReviewIntrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia.
Lipophilic opioids, especially fentanyl and sufentanil, are increasingly being administered intrathecally as adjuncts to spinal anesthesia. This review analyzes the efficacy of these opioids for subarachnoid anesthesia. ⋯ The anesthesia-enhancing properties and side-effect profile of lipophilic opioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Clinical TrialFrequency of hypotension during conventional or asymmetric hyperbaric spinal block.
The purpose of this randomized, double-blind study was to evaluate if use of an asymmetric spinal block affects the incidence of hypotension during spinal anesthesia. ⋯ Achieving an asymmetric distribution of spinal block by injecting a small dose of 0.5% hyperbaric bupivacaine through a Whitacre spinal needle into patients placed in the lateral position for 15 min reduces the incidence of hypotension during spinal anesthesia.
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Reg Anesth Pain Med · May 1999
Biography Historical ArticleRalph Waters as a regional anesthesiologist.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Clinical TrialQuantitative sensory changes in humans after intravenous regional block with mepivacaine.
In previous studies we have demonstrated that after intravenous regional block (IVRA) with dilute mepivacaine, there is a decrease in neurogenic inflammation as well as in post-ischemic hyperemia and steady-state flow, the latter for at least 60 minutes. It is unclear whether these vascular reactions reflect a uniform depression of nerve function in the treated arms. Because the various afferents convey impulses from different types of sensory receptors, we used quantitative sensory testing (QST) to define these effects of IVRA with mepivacaine. ⋯ There was no uniform depression of nerve function after IVRA. The cold receptors and/or their Adelta-fibers were selectively depressed after the block. In conjunction with earlier findings, this suggests that IVRA with mepivacaine can differentially decrease neurogenic inflammation, with little impairment of sensory function.