Regional anesthesia and pain medicine
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Based on case reports of early anastomotic leakage in patients receiving epidural analgesia with local anesthetic and data to document a stimulatory effect of epidural block on gastrointestinal motility, it has been suggested that continuous infusion of epidural local anesthetic may lead to an increased incidence of anastomotic leakage. Therefore, we examined the association between continuous epidural local anesthetic and anastomotic leakage by reviewing the literature. ⋯ So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to be associated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialAssessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy.
The effectiveness of local anesthetic wound infiltration for treatment of postoperative pain appears to be variable and partly dependent on the surgical procedure. Although evidence was lacking, it was common practice at our institution to infiltrate the trocar wound of patients undergoing day-case laparoscopic procedures with long acting local anesthetic agents. The aim of this study was to investigate the analgesic efficacy, and the influence of the timing, of local anesthetic infiltration into surgical wounds for day-case diagnostic gynecological laparoscopy. ⋯ Wound infiltration with local anaesthetic did not significantly reduce pain or opioid requirement after gynecological laparoscopy.
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Reg Anesth Pain Med · Mar 2001
Randomized Controlled Trial Clinical TrialHypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion.
[corrected] For decades, hypotensive anesthesia has been used in an attempt to reduce intraoperative blood loss. Hypotensive epidural anesthesia (HEA) is a relatively new technique in hypotensive anesthesia. Use of a tourniquet has been shown to be associated with a higher risk of cardiovascular and thromboembolic complications. The effect of HEA on blood loss and need for transfusion in total knee replacement (TKR) is not known. ⋯ We conclude that HEA is a safe technique that allows TKR without a tourniquet. Compared with spinal anesthesia, the use of HEA for TKR significantly reduces blood loss and the need for blood transfusion.
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Reg Anesth Pain Med · Mar 2001
Case ReportsThoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma.
The need for continual neurological assessment in patients with lumbar spinal injury poses a challenge for effective management of pain associated with multiple fractured ribs. Two cases are presented to illustrate the benefits of using thoracic paravertebral block to control the pain of multiple fractured ribs without compromising the ongoing neurological assessment. ⋯ Thoracic paravertebral block is an option for managing pain associated with multiple fractured ribs in the presence of concomitant lumbar spinal injury requiring continual neurological assessment.
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Reg Anesth Pain Med · Mar 2001
Case ReportsCombined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain-Barre syndrome.
The anesthetic management of labor, delivery, and cesarean delivery in patients with active or resolving Guillain-Barre syndrome is not well defined. Using a combined spinal and epidural (CSE) technique in such a rare clinical situation has not been previously reported. ⋯ Careful evaluation and documentation of the patient's baseline neurological status, a thorough discussion with the patient regarding the risks and benefits of the technique for labor analgesia, and an appreciation of the limited experience with this kind of clinical situation are important.