Regional-Anaesthesie
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Regional-Anaesthesie · Jul 1984
Clinical Trial[0.5 mg intrathecal morphine in spinal anesthesia. A double blind study on sensory block, postoperative analgesia and adverse effects].
In a randomized double-blind study the influence of morphine 0.5 mg on the development and regression of spinal anaesthesia, the postoperative analgesia and the side effects were investigated. Forty-two patients received an isobaric spinal anaesthesia with tetracaine 20 mg without morphine (n = 19) or with morphine 0.5 mg (n = 23). The sensory blockade was tested by pinprick; the patients evaluated their postoperative pain with an analogue scale. ⋯ Following spinal anaesthesia with a deeper level of anaesthesia at T8-T11 the postoperative analgesia was superior than following spinal anaesthesia with a higher level of anaesthesia at T3-T4 (p less than 0.05). Only following higher levels of anaesthesia there was evidence of respiratory depression (p less than 0.05). This is why the level of spinal anaesthesia with the addition of morphine must not be higher than necessary for surgery.
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We tested a new epidural catheter, which is made of a stainless steel spiral (similar to an anode endotracheal tube) covered with a fluorpolymer. This catheter was tested in 15 patients who were administered lumbar epidural anaesthesia for pain relief during labor. ⋯ The main advantage of this catheter is, that it does not kink. The disadvantages are: 1. catheter leakage either at the skin interface or just below the injection port particular after prolonged usage, 2. difficult or impossible injection if the catheter injection port is screwed on too tight which requires cutting the catheter (not recommended by the manufacturer), 3. a 17 gauge rather than a 18 gauge epidural needle is recommended and 4. the high price of the catheter.
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Regional-Anaesthesie · Jul 1984
Case Reports[Continuous, long-term peridural morphine analgesia in an ambulatory cancer patients].
For the treatment of cancer patients opioids can be administered epidurally. Continuous epidural analgesia with morphine, carried out with an externally portable pump, which can be programmed as to dosage, offers certain advantages as compared to a bolus injection. In contrast to the method of implanting a pump system our procedure is considerably less invasive, more economical, due to reusage of the pump, and more convenient to the patient.
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Regional-Anaesthesie · Jul 1984
[Electrical nerve localization and catheter technic. A safe method for brachial plexus anesthesia].
A technique for sub-axillary blockade of the brachial plexus by means of a special catheter set is presented. A plastic self-retaining cannula is placed within the vasomotor nerve sheath, using the advantages of electric nerve stimulation. In our opinion the decisive advantages of this procedure lie in the fact that the user is not dependent on the cooperation of the patient and anatomical orientation takes place on the basis of clear and objective criteria through the muscle contractions induced in this way. ⋯ This method makes subsequent injections into the vasomotor nerve sheath through repeated puncture unnecessary. The catheter technique makes it possible to operate on the upper extremity using regional anaesthesia, whose effects can be prolonged beyond those of long-acting anaesthetics. The possibility of incomplete blockade resulting from individual variations in the amounts of local anaesthetics needed, is excluded and the anaesthetist can, if necessary, carry out pre- and post-operative pain therapy.
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Regional-Anaesthesie · Apr 1984
Case Reports[Cutaneous cerebrospinal fluid fistula associated with secondary puncture of the dura caused by a peridural catheter].
Prolonged liquor fistula following puncture of the subdural space for diagnostic or anaesthetic purposes has been reported repeatedly. These among other factors are held responsible for headache as well as neurological complications in connection with lumbar puncture. ⋯ Two patients developed a cutaneous liquor fistula after lumbar laminectomy following an inadvertant dural penetration when an epidural steroid injection was performed. The same occurred in a healthy young patient who had undergone several trials to puncture the epidural space for an epidural anaesthesia in a case of emergency cesarean section Our own observation concerns a 62 years old woman who developed a cutaneous cerebrospinal fluid fistula 12 h after the removal of an epidural catheter, which had caused a secondary perforation of the dura.