Regional-Anaesthesie
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Regional-Anaesthesie · Apr 1986
Comparative Study Clinical Trial Controlled Clinical Trial[Comparison of the effect and serum level of mepivacaine HCL and mepivacaine CO2 in axillary brachial plexus anesthesia].
The latency period and spread of axillary plexus block using 40 ml mepivacaine carbonate (1% solution) or mepivacaine hydrochloride was studied in thirty patients scheduled for surgery of the hand-forearm region. The sensory block of the nervus axillaris, musculocutaneus, radialis, medianus, ulnaris and cutaneus brachii medialis was recorded using the pin prick test every 4 min after injection and the motor block was assessed by testing the strength of the corresponding muscles. ⋯ A comparison between the serum levels of the first five patients of each group showed a faster increase and a higher level after the injection of carbonated mepivacaine. Carbonated mepivacaine doesn't have any practical advantage for axillary plexus block.
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Regional-Anaesthesie · Oct 1985
Comparative Study Clinical Trial Controlled Clinical Trial[Comparison of prilocaine 2% versus lidocaine 2% with adrenaline in peridural anesthesia. A clinical double-blind study].
Sensory and motor blockade as well as formation of methaemoglobin were investigated under controlled double-blind conditions following epidural anaesthesia with prilocaine 2% or lignocaine 2%, each with adrenaline 1:200,000. 20 ml (= 400 mg) of these two solutions were administered to two groups, each consisting of 10 patients. Sensory blockade was tested with the pin prick method, motor blockade with the Bromage score and the rectus abdominis-muscle (RAM)-test. Venous methaemoglobin was determined before and 2,5 h after administration of the local anaesthetic. ⋯ Methaemoglobin always increased following prilocaine, but not following lignocaine. One patient had an increase of methaemoglobin from 0.8 rel% before to 13.8 rel% after administration of prilocaine. The differences of sensory and motor blockade are of secondary importance for clinical practice; while lignocaine shows higher toxicity to the central nervous and cardiovascular system, prilocaine forms methaemoglobin.
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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.