Regional-Anaesthesie
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Regional-Anaesthesie · Jul 1987
Comparative Study[Comparative study of circulatory and ECG-changes after supraclavicular plexus block with bupivacaine-HCl 0.5 per cent in patients with chronic kidney failure].
The systemic effects of local anesthetic drugs, especially bupivacaine, on myocardial conduction and the increase of cardiotoxicity by hypoxemia, acidosis, and hyperkalemia has been proven in numerous animal experiments. In our department, supraclavicular brachial block with bupivacaine is the method of choice for patients with chronic renal failure requiring operations of the upper limb. The question may be raised whether or not these patients with their concomitant disease--electrolyte and acid-base imbalances, uremic cardiomyopathy--are especially endangered by the use of this drug. ⋯ Comparing the two groups, no severe changes in electrolytes or acid-base status could be found despite some statistical significances. Even though bupivacaine serum concentrations proved to be 3 times higher in the study group than in the control group, no changes in cardiac conduction could be registered. We conclude that bupivacaine is as safe in dialyzed patients with chronic renal failure with regard to possible changes in circulatory parameters and myocardial conduction as in healthy patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Apr 1987
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of 1% prilocaine and 1% mepivacaine in axillary plexus anesthesia].
In a randomized double-blind study, the latency period and spread of axillary brachial plexus block using 40 ml mepivacaine hydrochloride (1% solution), or prilocaine (1% solution) was studied in 60 patients scheduled for surgery of the hand and forearm regions. The sensory block of the axillary, musculocutaneus, radial, median, ulnar and medial brachial cutaneous nerves was recorded using the pin-prick test every 5 min after injection and the motor block was assessed by testing the power of the corresponding muscles up to 30 min after injection. The degree of intraoperative analgesia attained was also determined. ⋯ The methemoglobin level was always elevated following prilocaine, but not following mepivacaine. Two patients had an increase of the methemoglobin concentration to more than 11% after the administration of prilocaine. Neither the higher toxicity to the central nervous and cardiovascular systems from mepivacaine, nor the methemoglobin formed by prilocaine seems to be of clinical significance with the dosage and technique employed.
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Regional-Anaesthesie · Apr 1987
[Indications and possibilities of blockade of the sympathetic nerve].
Treatment of chronic pain through permanent or temporary interruption of sympathetic activity is marked by great clinical success, but nevertheless there are rather skeptical reports about long-term results of these blocks as therapeutic measures. There are many symptoms and signs of chronic pain, while diagnosis is expensive, the pathogenesis is complex, and the etiology is generally due to multiple factors. Indications for sympathetic blockade depend upon the possible means of access, as in the cervicothoracic, thoracic, lumbar, or sacral regions. ⋯ During the last 16 years we performed 15,726 sympathetic blockades on 2385 patients, which included: 3735 stellate ganglion blocks, 6121 blocks of the lumbar sympathetic trunk, 5037 continuous peridural anesthesias, 29 blocks of the thoracic sympathetic trunk, and 12 celiac blocks. In 792 cases sympathetic blocks were performed using neurolytic drugs, in most cases 96% ethyl alcohol and less often 10% ammonium sulphate. Other possibilities, such as enteral administration or infusion of sympatholytic drugs, were not taken into consideration; regional intravascular injection of guanethidine can be recommended, however.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthetists performing spinal and epidural anaesthesia will inevitably be confronted with the problem of postspinal headache. Exact knowledge as to cause, diagnosis, and treatment of this troublesome complication are mandatory. The most important method of treatment, the epidural blood patch, belongs to the armamentarium of every anesthetist. The present review is based on the most important findings in the literature and adds some important experiences from the author's institution.
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Regional-Anaesthesie · Jan 1987
Case Reports[A complication of continuous blockade of the femoral nerve].
The continuous femoral nerve block is an effective method of analgesia after knee surgery. We report a case with acute compression syndrome of the femoral nerve caused by a subfascial hematoma. The symptoms developed 30 h after induction of the block. Immediate decompression brought pain relief and prevented permanent neurologic sequelae.