Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2000
Comment Letter Clinical TrialTreatment of pain from vertebral compression fractures caused by osteoporosis.
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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.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans.
Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome. ⋯ A low-dose epidural infusion of epinephrine decreased anesthetic requirements.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialEffects of immediately initiating an epidural infusion in the combined spinal and epidural technique in nulliparous parturients.
Intrathecal fentanyl with bupivacaine provides rapid labor analgesia of limited duration. We investigated the effect of initiating an epidural infusion of 0.1% ropivacaine with fentanyl 2 microg/mL and epinephrine 1:400,000 (REF) on the duration of analgesia and incidence of side effects after intrathecal injection in the combined spinal and epidural technique. ⋯ Initiating an infusion of REF prolongs the duration of analgesia, but also results in a greater decrease in blood pressure. Despite this effect on blood pressure, there was no difference in ephedrine use.