Regional-Anaesthesie
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Regional-Anaesthesie · May 1990
Randomized Controlled Trial Comparative Study Clinical Trial[The equipotency of ropivacaine, bupivacaine and etidocaine].
Ropivacaine, congenerate to bupivacaine and mepivacaine has been widely studied in laboratory animals, but there have been few investigations of its efficacy in human epidural anesthesia and peripheral nerve blocks. The aim of this study was to compare the three long-acting local anesthetics (bupivacaine 0.75%, ropivacaine 1% and etidocaine 1%) and to try, with reference to previous studies, to make some statement about the equipotency of ropivacaine relative to bupivacaine and etidocaine. METHODS. ⋯ CONCLUSION. The results of this study indicate that ropivacaine is an effective local anesthetic agent. Its potency is about equal to that of bupivacaine and much higher than that of etidocaine...
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Regional-Anaesthesie · May 1990
Comparative Study Clinical Trial Controlled Clinical Trial[Ropivacaine in epidural anesthesia. Dose-response relationship and a comparison with bupivacaine].
Ropivacaine is a new long-acting local anesthetic with a pharmacodynamic profile resembling that of bupivacaine; in addition, ropivacaine has been shown to be less cardiotoxic than bupivacaine in dogs and pigs. To test the dose-response relationship of ropivacaine 0.75% (epinephrine 1:200,000) given epidurally, 47 patients were divided into three groups; the first group received 15 ml (n = 16), the second 20 ml (n = 15), and the third group, 25 ml (n = 16) ropivacaine. Further, to compare bupivacaine 0.75%, bupivacaine 0.5% and ropivacaine 0.75% for epidural anesthesia, 15 ml bupivacaine 0.75% (n = 15) or bupivacaine 0.5% (n = 15) or ropivacaine 0.75% (n = 16) was given epidurally, all with epinephrine added to the solution (1:200,000). ⋯ A total of 77 patients with ASA I or II were enrolled in a non-randomized open-label study. All patients were scheduled for varicose vein stripping. Male and female patients aged 18-70 and weighing 50-100 kg were included in the study. Patients were all placed in a sitting position and the epidural space was identified by the "loss of resistance" technique using a midline approach at the L 3/4 interspace; a test dose of 3 ml local anesthetic was then given, followed by injection of the remainder of the local anesthetic at the rate of 10 ml/min 1 min later. Following injection patients were immediately positioned supine. Upward and downward spread of analgesia were determined bilaterally by the pin-prick method, motor blockade was assessed by use of the Bromage scale following each determination of analgesia. Heart rate and blood pressure were obtained immediately before blockade and every 5 min until 3 h after the injection. RESULTS. The different volumes of ropivacaine 0.75% (15, 20, and 25 ml) brought about adequate analgesia in the sacral and lumbar regions in all patients. In the thoracic region T 6, T 5 and T 4 were reached. The time of onset of analgesia (segment L-1 in all three groups) was 6.4 +/- 2.9 min, 7.7 +/- 2.3 min, and 5.6 +/- 2.9 min for the 15-, 20- and 25-ml groups, respectively. The highest thoracic dermatome was reached after 20 +/- 6 min, 26 +/- 11 min, and 18 +/- 5 min. The duration of sensory anesthesia at the T 10 dermatomal level was 250 +/- 68, 249 +/- 77, and 278 +/- 51 min. Two-segment regression time was 160 +/- 67 min for bupivacaine 0.75%, 140 +/- 60 min for bupivacaine 0.5%, and 124 +/- 29 min for ropivacaine 0.75%. The total duration of sensory block was 303 +/- 58, 290 +/- 70, and 343 +/- 55 min for 15-, 20- and 25-ml groups, respectively. The degree of motor block achieved was 1.6, 1.8, and 2.0 (Bromage), respectively. Sensory anesthesia was considered adequate for surgery in all patients, and no signs of systemic toxicity were observed in any of the patients. The comparison of bupivacaine 0.75%, bupivacaine 0.5% and ropivacaine 0.75% revealed the same latency period of analgesia for bupivacaine 0.75% and ropivacaine 0.75%. This was shorter than for bupivacaine 0.5% (bupivacaine 0.75%: 6.4 +/- 2.1, bupivacaine 0.5%: 7.8 +/- 4...
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Regional-Anaesthesie · May 1990
Case Reports[Subdural spread of a local anesthetic following installation of a peridural catheter].
We report 4 cases of inadvertent subdural injection of local anesthetics among 640 patients receiving epidural anesthesia. In contrast to subarachnoid injection a typical sign was the development of patchy anesthesia in cervical segments and with late onset of symptoms. The case of a 63 year old woman scheduled for aortofemoral bypass surgery in epidural anesthesia is reported. ⋯ Her trachea was therefore intubated; 30 min later the level of anesthesia was below T5 and she could be extubated. Uneventful cesarean section was then performed. These cases demonstrate that as well as subarachnoid injection, inadvertent subdural injection of local anesthetic agents is a potential hazard of epidural anesthesia, not only in patients in an advanced state of pregnancy but also in nonpregnant patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · May 1990
[A clinical report of 11 years' experience of anesthesia for cesarean section (n = 721)--particularly spinal anesthesia (n = 648)--in a hospital outpatient clinic].
Experience with anesthesia for cesarean sections in a small obstetric and gynecology clinic attached to a general hospital is reported. The course of cases and the particular circumstances are described. During a period of 11 years 721 cesarean sections were performed, 643 (90%) under hyperbaric spinal anesthesia. ⋯ There were no severe complications or deaths related to anesthesia. Some important points related to spinal anesthesia for cesarean sections are mentioned. The results show that with attention to detail and observation of correct procedures by qualified anesthetists, the vast majority of cesarean sections can be done very successfully under spinal anesthesia.
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Regional-Anaesthesie · May 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Postoperative peridural analgesia via catheter following abdominal surgery. Peridural bupivacaine versus buprenorphine].
Seventy-five patients scheduled for major abdominal operations were randomly divided into four groups, each with a different postoperative analgesic regime. Group I: buprenorphine 4 micrograms/kg was injected i.v. every 4 h. Groups II-IV: all patients were preoperatively supplied with a thoracic epidural catheter that, however, was not used during the operation. ⋯ No patient in any of the other groups, however, was dropped (P less than 0.01). Later in the 1st postoperative day analgesia in groups II and IV lost its superiority at rest, but coughing continued to be less painful in comparison to groups I and III. We noticed that the duration of action of 0.25% bupivacaine, injected as a bolus, was considerably shorter than expected (less than 2 h) and that several patients experienced pain before the next top-up was given...