Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of continuous epidural infusion and intermittent intravenous bolus doses of morphine in children undergoing selective dorsal rhizotomy.
Selective dorsal rhizotomy (SDR) is associated with moderale to severe postoperative pain. Although the efficacy of epidural analgesia in this population has been demonstrated, it has not been compared with conventional intravenous (i.v.) analgesia. This prospective study compared the effects of epidural and i.v. morphine regarding postoperative analgesia, side effects, and outcomes in children following SDR. ⋯ Both techniques provided effective postoperative analgesia with a similar incidence of side effects; however, our findings suggest that continuous infusions of epidural morphine improved overall comfort with lower pain scores, fewer muscle spasms, and improved tolerance of activity during the initial postoperative period.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Comparative Study Clinical TrialCardiovascular effects of 6% hetastarch and lactated Ringer's solution during spinal anesthesia.
The purpose of this prospective, randomized, double-blinded study was to compare the hemodynamic effects of 6% hetastarch with lactated Ringer's solution and to determine the main reasons for hemodynamic impairment following spinal anesthesia in elderly patients undergoing emergent hip surgery. ⋯ Six percent hetastarch minimizes the hemodynamic responses during spinal anesthesia in elderly patients undergoing emergent hip surgery. In this study population, spinal anesthesia-induced hemodynamic impairment is caused by decreases in cardiac filling pressures and systemic vascular resistance.
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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.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialOver-the-needle versus microcatheter-through-needle technique for continuous spinal anesthesia: a preliminary study.
A new catheter-over-needle design (Spinocath, B. Braun) has been developed to minimize problems and complications of continuous spinal anesthesia with microcatheters, which include difficult catheter insertion, failure of insertion, breakage, inadequate anesthesia, postdural puncture headache, and, rarely, development of cauda equina syndrome. ⋯ Insertion, maintenance, and clinical effects were better achieved with the catheter-over-the needle design compared to the microcatheter. These preliminary findings need to be confirmed by a larger study.
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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.