Regional-Anaesthesie
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A new device for continuous axillary plexus block is described. Using the "loss-of-resistance"-method as in peridural anesthesia it allows a safe introduction of a catheter within the neurovascular axillar sheath. ⋯ The main field of application for this device is seen in the management of pain postoperatively, mobilisation of contracted joints as well as in sympathetic block for peripheral vascular disease of various etiology. Furthermore, its allows the anaesthesia of the axillary plexus for operations of long duration (i.e. plastic surgery).
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Regional-Anaesthesie · Jan 1983
[Unremovable epidural catheter due to a sling and a knot. A rare complication of epidural anesthesia in obstetrics].
An epidural catheter inserted at the height of L2/3 could not be removed after spontaneous delivery of a healthy boy, manual extraction of the placenta and fixing the episiotomy. X-rays (lumbar spine a-p and lateral) were taken in order to visualize the epidural catheter's site. The catheter could only be recognized on the a-p but not on the lateral film. ⋯ In a final trial pulling hard the catheter broke. The indication for operative extraction was given. Finally the catheter fixed in the ligamentum flavum building a loop and a tight knot in the epidural space could be freed up and removed surgically.
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From 1979-1981, a total of 355 high risk patients were scheduled for vascular surgery under lumbar spinal or epidural anaesthesia. 201 patients were given spinal anaesthesia and 140 patients continuous epidural anaesthesia. 14 patients had punction failure. The analgesia for vascular surgery on the lower extremities done under spinal anaesthesia was adequate in 193 patients (98%) and insufficient in only 4 patients (2%). Epidural anaesthesia was adequate for 117 patients (96%) and insufficient in 5 (4%). ⋯ Lumbar spinal and epidural anaesthesia are therefore alternative methods to general anaesthesia for high risk patients undergoing vascular surgery, especially on lower extremities. Spinal anaesthesia offers reliable surgical analgesia and good muscle relaxation but it is limited in time. Continuous epidural anaesthesia on the other hand does guarantee unlimited operating time and provides pre- and postoperative pain relief.
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Regional-Anaesthesie · Oct 1982
[Effectiveness of obstetric epidural analgesia. II. Caesarean section].
A questionnaire was sent to 260 women who in 1979 had undergone a caesarean section under either epidural or general anaesthesia. Those women who had an epidural for their caesarean section were on average very well informed about the procedure. In contrast, those who had been given a general anaesthetic felt that they had been badly or inadequately informed. ⋯ Headache, back pain and other complaints such as abdominal pain and wound pain were significantly more frequent in the general anaesthetic as compared to the epidural group. 85.8% of the women given an epidural said that they would choose the same again for a future caesarean, 12.1% would not. Of the group given a general anaesthetic, 29.9% said that in the future they would choose an epidural, and 62.3% that they would prefer to have a general anaesthetic again. The Apgar score at one minute, and the umbilical artery pH values of the newborn of the epidural group were significantly better than those of the general anaesthetic group, whereas at 5 and 10 min the Apgar scores of the babies of both groups showed no differences.
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Regional-Anaesthesie · Jul 1982
[Experiences with a method of continuous brachial plexus blockade following melanoma perfusion of an upper extremity].
A method of continuous brachial plexus blockade by an epidural catheter is reported. This kind of postoperative analgesia was applied to 10 patients over a period of 2-3 days after hyperthermic melanoma perfusion of the upper extremities. A sufficient analgetic effect was obtained by intermittent injection of local anesthetics.