Regional anesthesia and pain medicine
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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.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialUse of clonidine in hernia patients: intramuscular versus surgical site.
This study was designed to determine if administration of clonidine in hernia patients enhances analgesia. It was also designed to determine whether administration directly in the surgical site further improves the analgesia. ⋯ When clonidine is administered to patients undergoing hernia repair, the 2-hour pain scores are lowered. No difference was exhibited when clonidine was administered intramuscularly or directly into the hernia site.
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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.
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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.
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Reg Anesth Pain Med · Sep 1999
Randomized Controlled Trial Clinical TrialEfficacy of simulated intravenous test dose in the elderly during general anesthesia.
Reliability of detecting unintentional intravascular injection of the epinephrine-containing test dose is improved by decreasing the heart rate (HR) threshold to 10 beats/min during combined epidural and general anesthesia. We have tested whether this modified HR criterion is still applicable in the anesthetized elderly patients. ⋯ Our results indicate that the efficacy of the modified HR criterion using epinephrine-containing test dose is clinically applicable in most elderly patients, and the combination of the SBP and the modified HR criteria is reliable in detecting intravascular injection during combined epidural and general anesthesia.