Revista española de anestesiología y reanimación
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Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. ⋯ We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.
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Rev Esp Anestesiol Reanim · Oct 2004
Review Case Reports[Horner's syndrome following epidural analgesia for labor].
Horner's syndrome is a disorder of the sympathetic nerve supplying the eye. Infrequently, Horner's syndrome can arise as a complication of epidural anesthesia, but its clinical course is favorable. The incidence increases when epidural analgesia is used in obstetrics because of physiological and anatomic changes in obstetric patients that favor spread of the local anesthetic. ⋯ The case we report was the only one in our hospital over a period of 4 years during which 12,796 epidural procedures were performed. These data suggest to us that Horner's syndrome often passes undetected because clinical manifestations are not remarkable. Nevertheless, the diagnosis should be kept in mind so that unnecessary treatment is avoided, given that the clinical course is favorable with spontaneous resolution.
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Rev Esp Anestesiol Reanim · Oct 2004
Case Reports[Two cases of postpartum pubis diastasis mistaken for neurological complications of epidural analgesia].
Two healthy 31- and 34-year-old parturients received uncomplicated epidural analgesia for labor and delivery using standard techniques. Twenty-four and 12 hours postpartum, respectively, they developed severe lower back pain and difficulty moving their lower extremities. At first the symptoms were attributed to neurological complications of epidural analgesia and for this reason the anesthetist was called. ⋯ In the most severe cases it may be accompanied by urinary dysfunction and inability to walk. If the clinical features are not recognized, it can be difficult to differentiate pubis diastasis from severe neurological complications in women who have received a central nervous system block. We report two cases of peripartum pubis symphysis diastasis that were both initially mistaken for neurological complications of epidural analgesia for labor.