Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2002
Case ReportsAcute toxicity of local anesthetic ropivacaine and mepivacaine during a combined lumbar plexus and sciatic block for hip surgery.
Hip fracture is a common pathology in elderly patients. Intercurrent diseases, mainly cardiac and respiratory, often result in significant morbidity and mortality. Anesthesia for hip fracture can be provided by general or regional techniques. ⋯ All signs of toxicity disappeared after injection of midazolam and atropine, intubation and 100% oxygen ventilation. We decided to proceed with surgery. The postoperative course was uncomplicated and made a full recovery.
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Acta Anaesthesiol Belg · Jan 2002
Case ReportsLarge subcutaneous hematoma complicating epidural block.
We present a case of a large subcutaneous hematoma in the lumbar region that occurred after epidural block was performed for the relief of labor pain. Epidural analgesia was begun in a young and healthy primigravida. Eight hours later, she needed an emergency cesarean section. ⋯ Her postpartum course was complicated by an unexplained fever, which responded to antibiotic therapy and warranted prolonged hospitalization. Coagulation and bleeding studies were normal. We conclude subcutaneous hematoma after epidural block can cause significant morbidity and should be added to the list of neuroaxial block complications.
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Acta Anaesthesiol Belg · Jan 2002
Combined spinal epidural analgesia is the preferred technique for labour analgesia.
To justify its place as the preferred method of pain relief in labour, CSE must demonstrated a clear superiority over epidural analgesia. Looking at the relative efficacy of the two techniques failure rates appear to be equal. Speed of onset may be faster with an initial spinal injection although perhaps only clinically relevant in advanced labour where the quality of analgesia may sometimes be better. ⋯ What then is the place of CSE in labour analgesia? Its potential benefit makes it a reasonable option when there is a clear clinical advantage such as requests for analgesia in late labour or where maternal distress is extreme or where epidural analgesia has been ineffective. However even in such situations the slight increase in risk must be weighed against the possible advantage. Consequently the CSE cannot at the present time be recommended as the preferred option for labour analgesia.