Masui. The Japanese journal of anesthesiology
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Comparative Study
[Effect of intrathecal administration of opioid on minimum alveolar concentration and postoperative pain relief--a comparison of morphine and buprenorphine].
Intrathecal morphine (Mor) exerts potent analgesic effect and decreases anesthetic requirement. However, morphine was reported to have various uncomfortable side effects, and buprenorphine (BPN) is considered as an alternative opioid. The aim of this study was to investigate the effect of intrathecal BPN and Mor on the MAC of halothane and the relief of postoperative pain. ⋯ The decrease in halothane MAC with 0.05 mg intrathecal BPN was equipotent with the intrathecal administration of 0.5 mg Mor. Adequate postoperative analgesia and severe pruritus were observed in the 0.5 mg Mor group. The intrathecal administration of 0.05 mg and 0.075 mg BPN has shown mild analgesic effect without any side effects.
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We evaluated retrospectively the anesthetic management and perioperative complications of 47 patients with chronic spinal cord injury for genitourinary procedures. Of the 69 cases, 38 were performed under general anesthesia, 21 cases under spinal anesthesia, one case under epidural anesthesia, four cases under axillary block, and five cases under either sedation or standby. In preoperative laboratory findings, anemia was observed in 41%, hypoproteinemia in 38%, renal insufficiency in 23%, and restrictive pulmonary dysfunction in 69%. ⋯ Careful preoperative evaluation and anesthetic management are required for prevention and prompt treatment of perioperative complications related to the disorders. Autonomic hyperreflexia can be successfully prevented by either general anesthesia or spinal anesthesia. The increased anesthesia safety can be obtained by the successful management of the cardiovascular instability during surgery.
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A 27-year-old man underwent appendectomy under spinal anesthesia with 0.3% dibucaine 2.7 ml. The perioperative course was uneventful. The surgical procedure, however, lasted for 1.5 hours in the supine position. ⋯ The disorder was diagnosed as meralgia paresthetica caused by the surgical procedures. The numbness disappeared after the oral administration of mecobalamin in several days. In the treatment of a case like this, it is important to exclude neurological complications caused by spinal anesthesia.
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Randomized Controlled Trial Clinical Trial
[Preemptive analgesia produced with epidural analgesia administered prior to surgery].
The effect of epidural analgesia administered before or during surgery on postoperative pain relief using continuous epidural infusion of the mixture of local anesthetics and narcotics was studied. Ninety patients undergoing abdominal hysterectomy were randomly allocated to three groups; thirty patients of group 1 who received general anesthesia alone, thirty patients of group 2 with epidural analgesia 20 min before the end of surgery under general anesthesia and thirty patients of group 3 with epidural analgesia plus general anesthesia before surgery. Epidural analgesia was induced with 2% mepivacaine solution 15 ml without epinephrine in group 2 and 3, and in group 3 followed with 5 ml of the same solution at one-hour intervals. ⋯ Immediately after surgery, 5 ml of the mixture of 0.225% bupivacaine and 0.0005% fentanyl was injected epidurally and followed with continuous infusion of the same mixture at the rate of 2.1 ml.h-1 over 24 h. Visual analogue score and Prince-Henry score were significantly less in group 3 than in group 1 and group 2 at 4 hours and 24 hours after surgery (P < 0.01, P < 0.05 respectively). These results suggest that postoperative continuous epidural analgesia is more effective if the entrance of noxious stimuli into the central neural system is prevented by preincisional epidural block.
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Case Reports
[Failures of lumbar epidural analgesia caused by transforaminal passage of an epidural catheter in two cases].
In one case, analgesia level obtained with a 20 ml of 1.5% mepivacaine was unilateral and inadequate. In the other case, an epidural catheter was inserted after a 20 ml of 2% mepivacaine was injected through a Tuohy needle. ⋯ If an epidural catheter is advanced beyond 5 cm into the epidural space, it may migrate outwards through the intervertebral foramen. Therefore, the insertion of an epidural catheter should be limited to 3-4 cm.