Regional-Anaesthesie
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Regional-Anaesthesie · Jul 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Combined sciatic/3-in-1 block. III. Prilocaine 1% versus mepivacaine 1%].
In a randomized, double-blind study, the efficacy of prilocaine 1% (group 1, 30 patients) was compared to mepivacaine 1% (group 2, 30 patients). All patients had a combined sciatic/femoral block for surgery of the lower extremities; a tourniquet was applied in each case. In each patient the block was done using 50 ml of a 1% solution of local anesthetic: 20 ml for the sciatic and 30 ml for the 3-in-1 block. ⋯ On the average, patients were pain-free for 254 min with prilocaine and 267 min with mepivacaine. Four of 30 patients (= 13%) in group 1 an 6 of 30 patients (= 20%) in group 2 had an unsatisfactory blockade and had to be supplemented by analgesics or general anesthesia. The finding of a significant correlation between the voltage necessary for stimulation and the efficacy of the blockade underlines the importance of correct stimulation when identifying the nerves.
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Regional-Anaesthesie · Jul 1988
[Continuous spinal anesthesia using bupivacaine. Report of experiences].
Continuous spinal anesthesia has not yet found general acceptance, although it is a simple and efficient method. Its main advantage is allowing a reliable block to be built up step by step while carefully monitoring the cardiovascular changes. Postspinal headache can be avoided by restricting the use of elderly patients. ⋯ Two patients had to be intubated intraoperatively (1 unexpected laparatomy during vascular surgery, 1 with insufficient block for lumbar sympathectomy). The main technical problem was impossibility to advance the catheter into the subarachnoid space despite free flow of CSF (5 cases). For these patients single-shot spinal (4 cases) or epidural anesthesia (1 case) was used.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Apr 1988
[Continuous block of the lumbar plexus with the 3-in-1-block catheter technic in pain therapy].
The evaluation of the test protocols on continuous lumbar plexus blockade using the 3-in-1 block with a lumbar plexus catheter showed the following results: The study included 104 patients. In 91.3% of cases, puncture of the fascial sheath of the femoral nerve proved successful. In 95.7% of cases, the plexus catheter could be positioned and left in place (Table 1). ⋯ All catheters could be left in place without complications until the end of therapy. Changing the catheter is possible at any time, as is the replacement of the catheter hub. Such steps were carried out in 5 cases.
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Regional-Anaesthesie · Apr 1988
[Behavior of plasma concentrations of prilocaine following intravenous regional anesthesia and their relation to methemoglobinemia].
In a previous investigation we were able to demonstrate quite different methemoglobin levels after axillary plexus blockade on one side and intravenous regional anesthesia (IVRA) on the other using prilocaine (Fig. 1). At that time we tried to explain this observation by prolonged mobilization of the local anesthetic after tourniquet release, causing only minimal stress to the erythrocyte-related reduction system. In order to study prilocaine mobilization after tourniquet release in the upper limb following IVRA, prilocaine and methemoglobin concentrations were measured in 8 patients. ⋯ Remarkable differences in peak prilocaine concentrations (64 micrograms/ml vs 7.9 micrograms/ml after the 1st min) were found during the 3-h study period. The course of methemoglobin formation was similar to that in a group of patients we had studied previously (Fig. 4). Our findings confirm the assumption that the low and plateau-like methemoglobin formation following intravenous regional anesthesia of the arm is the result of delayed prilocaine release.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Combined ischiatic/3-in-1-block. II. 1 percent mepivacaine HCl versus 1 percent CO2 mepivacaine].
In a prospective randomized study on 26 patients, the clinical effectiveness CO2-mepivacaine 1% (group 1, 13 patients) and mepivacaine HCl 1% (group 2, 13 patients), was tested in patients having a sciatic-femoral block for surgical procedures of the lower extremity (20 ml for sciatic and 30 ml for 3-in-1 block). Blood levels of mepivacaine were determined for up to 90 min in 8 patients from each group. The onset of sensory and motor blockade was slightly earlier (4-5 min) with CO2-mepivacaine than with the hydrochloride (5-6 min). ⋯ There was a relatively large variance in intensity of blockade that was not necessarily related to the drug employed, but can be explained by individual factors and possibly by slight differences in blocking technique. Nevertheless, the rate of unsuccessful blockade was remarkably higher (38%) with the hydrochloride than with CO2-mepivacaine (7.7%). Determinations of blood levels did show the expected earlier peak (after 20-30 min) and higher blood-levels (means 3.8 micrograms/ml at 30 min) with CO2-mepivacaine 1% as compared to mepivacaine HCl 1%: 2.9 micrograms/ml at 30 min and 3.4 micrograms/ml at 45 min.