Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialEnhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine.
The acetylcholinesterase inhibitor neostigmine has shown peripherally mediated analgesic action in recent preclinical and clinical studies. The present study investigates the effectiveness of adding neostigmine to a local anesthetic, mepivacaine, in patients receiving axillary brachial plexus block for upper extremity surgery. ⋯ Peripherally administered neostigmine improves postoperative analgesia in axillary brachial plexus block.
-
Reg Anesth Pain Med · Sep 1999
Comparative Study Clinical TrialChanges in heart rate variability in elderly patients undergoing major noncardiac surgery under spinal or general anesthesia.
Heart rate variability (HRV), widely used as an indicator of activity of the autonomic nervous system, has been reported to decrease during and after both spinal and general anesthesia in patients without cardiovascular disease. We evaluated the changes in HRV bands in 40 patients with a high risk of ischemic heart disease. ⋯ The sympathovagal balance (LF/HF) is more stable during SA than during GA in patients with a high risk of ischemic heart disease. The postoperative decrease in HRV bands, however, is independent of the anesthetic technique.
-
Reg Anesth Pain Med · Sep 1999
Case ReportsDisappearance of wheezing during epidural lidocaine anesthesia in a patient with bronchial asthma.
Local anesthetics in blood absorbed from the epidural space attenuate bronchial hyperreactivity to chemical stimuli. However, it is not documented whether local anesthetics at clinically relevant concentrations improve active wheezing in patients with bronchial asthma. ⋯ At clinically relevant concentrations, lidocaine in the blood absorbed from the epidural space may improve bronchospasm in patients with bronchial asthma.
-
Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Comparative Study Clinical TrialInfraclavicular brachial plexus block: variation in approach and results in 360 cases.
Brachial plexus block is clinically useful. Although the infraclavicular approach to brachial block is the less commonly used form it may offer advantages. We describe the results with three local anesthetic mixtures used during this observational study. ⋯ The infraclavicular approach described is effective. It produced reliable anesthesia and is associated with minimal complications and side effects. The mixture of local anesthetics used in group II is not adequate for producing reliable anesthesia.
-
Reg Anesth Pain Med · Sep 1999
Lack of efficacy of an epidural blood patch in treating abducens nerve palsy after an unintentional dura puncture.
Unintentional dural puncture with a Tuohy epidural needle during the course of an epidural anesthetic may lead to a postdural puncture headache and double vision. We describe a parturient that developed left abducens nerve palsy after an epidural anesthetic for labor. ⋯ We believe that a dural puncture during an attempted epidural anesthetic resulted in cerebrospinal fluid (CSF) leakage with a consequent headache. The CSF leak caused traction on the sixth cranial nerve resulting in lateral rectus muscle palsy. An epidural blood patch performed after the onset of symptoms did not acutely resolve the abducens nerve palsy.