Regional-Anaesthesie
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In patients with cancer pain caused by tumours in the upper thorax, shoulder or neck area the thoracic approach for peridural opiate analgesia is indicated. The thoracic puncture technique is more difficult and the possible complications are more serious than puncture in the lumbar area; it therefore belongs, as pain therapy generally, in the hands of an anaesthesiologist experienced in regional anaesthesia. In selecting the puncture level appropriate to the site of pain, it is necessary to take account of the fact that the vertebral interspace does not correspond with the spinal segment. Only thus can an optimal analgetic effect with a minimal dose b assured.
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Regional-Anaesthesie · Jul 1985
[Catheter brachial plexus anesthesia for intra- and postoperative pain control. Plasma concentrations and analgesia interval in the use of bupivacaine].
In 15 orthopedic patients, undergoing plastic surgery of the upper extremity (elbow, forearm, hand) we studied plasma levels and pain free intervals, when performing catheter axillary plexus block with 0.5% and 0.25% bupivacaine as postoperative analgetic agent respectively. 30 minutes after injection of 40 ml of 0.5% bupivacaine maximum plasma levels were reached (means = 1.46 micrograms/ml), followed by a constant but slow decrease to 1 microgram/ml approximately after 2 h. 11.5 h (mean) after brachial plexus block there was a need for reinjection of local anesthetic solution for postoperative pain control. The pain free interval after 30 ml of 0.25% bupivacaine lasted 10.5 hours on the average. The 'top-up-dose' of 75 mg approximately equal to 30 ml of 0.25% bupicavaine caused only a small rise in plasma levels up to 0.6 micrograms/ml. Catheter brachial plexus block with bupivacaine is an appropriate procedure for both intra- and postoperative pain relief, especially in re-implantation surgery of the upper limb.