Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialBupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery.
Visceral pain decreases in cesarean patients under spinal anesthesia when the dose of local anesthetic is increased. However, larger doses of local anesthetic are associated with higher sensory blocks. We hypothesized that the addition of fentanyl could reduce the dose of bupivacaine necessary to achieve adequate surgical anesthesia. ⋯ The optimal dose of hyperbaric bupivacaine to produce surgical anesthesia was 12 mg, which was accompanied by high sensory block. With the addition of 10 microg of fentanyl, the dose of bupivacaine could be reduced to 8 mg in spinal anesthesia for cesarean delivery.
-
Reg Anesth Pain Med · May 2000
Comparative Study Clinical Trial Controlled Clinical TrialLow-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.
The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension. ⋯ Bupivacaine 5 mg + fentanyl 25 microg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.
-
Reg Anesth Pain Med · May 2000
Comment Letter Comparative StudyTime and incidence of paresthesia comparing spinocath with microintralong.
-
Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialA randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents.
Pain and gastrointestinal dysfunction are primary factors that delay recovery after posterior spinal fusion. Previous reports suggest that the choice of analgesic management may effect the course of recovery. This prospective, randomized study compared continuous thoracic epidural analgesia and patient-controlled analgesia in the postoperative care of adolescents undergoing posterior spinal fusion for idiopathic scoliosis. ⋯ Continuous epidural analgesia and patient-controlled analgesia are comparably effective and safe after posterior spinal fusion. Return of bowel sounds occurred significantly more rapidly in patients receiving CEA postoperatively.
-
Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture.
Combined spinal epidural anesthesia (CSEA) involves the epidural administration of local anesthetic and opioid solutions adjacent to the prior dural puncture, potentially increasing their diffusion into the subarachnoid space. This study was designed to evaluate the influence of dural puncture on the adequacy and extent of analgesia, and drugs requirements of patient-controlled epidural analgesia (PCEA) in the postoperative period. ⋯ Dural puncture with a 25-gauge Quincke needle, performed as part of CSEA, does not influence the drug requirements when a combination of 0.1% bupivacaine and fentanyl (3 microg/mL) is used for PCEA after major abdominal surgery.