Minerva anestesiologica
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Ropivacaine is a relatively new long-acting local anesthetic. It is a pure S(-) isomer, with a high pKa and low lipid solubility. Because of its physical and chemical properties, ropivacaine produces a marked differential in sensory and motor blockades, with a toxic potential lower than other long-acting anesthetic solutions. The purpose of this paper was the evaluation of the literature concerning indications and advantages of ropivacaine for different regional anesthesia techniques. ⋯ Ropivacaine is a long-acting local anesthetic with a marked differential blockade between sensory and motor fibres, overall at the low concentrations used for postoperative analgesia. It probably has a slightly lower potency as compared with bupivacaine, but provides similar clinical efficacy in the different fields of regional anesthesia. Ropivacaine is less cardiotoxic and causes less central nervous system toxicity than bupivacaine, and this lower toxic potential has been reported not only with equivalent but also with equipotent concentrations and doses. For this reason, ropivacaine represents a useful alternative to bupivacaine for central and peripheral nerve blocks as well as for the management of postoperative pain relief.
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Minerva anestesiologica · Sep 2001
ReviewSufentanil: an overview of its use for acute pain management.
The knowledge of pharmacodynamics and pharmacokinetics of new opioid drugs is necessary so that anaesthesiologists can choose which one to use, considering the patient's pathophysiology, the surgical procedure, and the dose required to obtain the desired effect. Aim of this review was to evaluate relevant trials on perioperative sufentanil in order to design an optimal strategy for administration. ⋯ Efficacy of sufentanil in perioperative epidural or intravenous analgesia resulted the same or better than other drugs used commonly despite context-sensible half-life advantages. Its association with local anaesthetics or adjuvant drugs prolongs its action and sometimes decreases the side effects. From the examined trials results that sufentanil can be used at very low doses and its association with local anaesthetics, clonidine, ketamine, and adrenaline by epidural, intravenous or intrathecal route for perioperative analgesia (intra and postoperative) and by various types of administration (PCA, PCEA, fixed intervals doses, continuous infusion, etc.).
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Bupivacaine is a local anaesthetic of great potency and long duration but has also well known cardio-and CNS toxic side-effects. For many years it was nearby the only local anaesthetic with these characteristics, making it applicable to almost all kind of loco-regional anaesthetic techniques, and still nowadays, for economical reasons it is in many occasions the only alternative available. ⋯ According to these analysis we concluded that this drug, though still remaining a good alternative in many fields of loco-regional anaesthesia (like peripheral blocks), as well as an efficient drug equal to the above mentioned ones in any sector like epidural analgesia in caesarean section, its best indication is subarachnoideal anaesthesia (combined and not) where it is the best available drug in hyperbaric solution without doubts. It might be interesting in the next future the comparison with hyperbaric solutions of levobupivacaine (not yet available).
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Minerva anestesiologica · Sep 2001
Review Comparative Study[Spinal or epidural anaesthesia for caesarean section? Compared opinions].
Regional anaesthesia during caesarean section reduces mortality directly related to anaesthesia. Epidural anaesthesia is a good choice when an epidural anaesthesia was performed during labor. General anaesthesia is recommended only for emergency caesarean section and when regional anaesthesia is contraindicated. ⋯ Epidural opiates have a lower incidence of maddening side effects compared with spinal opiates and allow better maternal satisfaction as regard postoperative analgesia. In accordance with ASA guidelines there are no decisive reasons in order to choice spinal or epidural block: actually literature is unable to give a definitive suggestion about complications and advantages. The choice would be take place weighing up maternal wishes, fetal factors (elective versus urgent caesarean section) and the preferences of the anesthesiologist.
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Peripheral neural blockade techniques are commonly used procedures to provide perioperative anesthesia and analgesia. Several continuous infusion catheter techniques have been described to extend the use of peripheral neural blockade into the postoperative period as an effective method of providing pain management. The analgesic benefit of continuous local anesthetic peripheral block in the management of postoperative pain is primarily related to the properties of providing intense analgesia thereby reducing perioperative opioid requirements and opioid-related side effects and promoting early recovery of postoperative activity. ⋯ The sciatic nerve is the largest nerve in the body and it lies deep in the posterior thigh. According to its anatomy, the sciatic nerve can then be reached at different levels from the parasacral space to the popliteal fossa, ideally identifying a sciatic line running from the inferior border of the gluteus maximus muscle between the greater throcanter and the ischiatic tuberosity to the popliteal fossa. A variety of continuous peripheral blocks have been described in this paper including continuous sciatic block at several levels (para-sacral nerve block, subgluteal sciatic nerve block) and popliteal nerve block.