Regional-Anaesthesie
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Regional-Anaesthesie · Aug 1990
[Maternal and neonatal plasma concentrations of bupivacaine during peridural anesthesia for cesarean section].
Many anesthesiologists prefer epidural anesthesia for cesarean section because of the potential risks of general anesthesia such as Mendelson's syndrome. For this indication, the local anesthetic of first choice is the long-acting substance bupivacaine. The aim of the following study was to determine maternal and neonatal plasma concentrations of bupivacaine 0.5% following epidural anesthesia for cesarean section in order to give critical statements about the systemic toxicity of the local anesthetic. ⋯ Using bupivacaine 0.5% for epidural anesthesia for cesarean section, we found maternal and neonatal plasma concentrations of the local anesthetic far below the accepted threshold level for producing systemic toxic reactions. In contrast to others, we obtained good analgesia and sufficient motor blockade accompanied by low plasma levels. In our opinion, there is no need to use 0.75% bupivacaine, especially since peak plasma concentrations of more than 2 micrograms/ml occur shortly after its epidural administration.
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Regional-Anaesthesie · Jul 1990
[Intravenous regional anesthesia of the foot using prilocaine. Clinical aspects, pharmacokinetic and pharmacodynamic studies].
Intravenous regional anesthesia (IVRA) of the foot is a rarely used but alternative method to other regional techniques and general anesthesia, especially when operating on the distal portion of the lower limb. The present report describes our method and experience with this type of anesthesia in approximately 500 patients, including pharmacokinetic and -dynamic aspects. MATERIALS AND METHODS. ⋯ In order to avoid systemic toxic reactions, the use of prilocaine is recommended. Prolocaine plasma concentrations and methemoglobin formation were both far below toxic levels. Failure of IVRA was probably caused by premature outflow of the local anesthetic solution, as shown by the course of prilocaine plasma concentrations and methemoglobinemia.
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Regional-Anaesthesie · Jul 1990
Comparative Study[Axillary blockade of the brachial plexus using 60 ml prilocaine 0.5% vs. 40 ml prilocaine 1%. A clinical study of 144 patients carried out by the determination of the prilocaine concentration in the central venous blood and by the measurement of the subfascial pressure in the plexus following the injection].
We estimated in this study the efficacy of axillary plexus blockade with 60 ml prilocaine 0.5% (300 mg). Following electrostimulation of the median, radial or ulnar nerve (depending on the area of the hand to be operated on), we injected prilocaine in two groups of patients (large volume group, 60 ml prilocaine 0.5% in 20 s; n = 114 patients; normal volume group, 40 ml prilocaine 1% in 20 s; n = 30 patients). Anesthesia of the median and ulnar nerves was virtually complete in all patients, but anesthesia of the radial and musculocutaneous nerves was complete in only 67% (radial) and 75% (musculocutaneous) in the group with normal injection volume. ⋯ Estimation of the prilocaine concentration in the central venous blood 120 min after injection did not reveal different plasma concentrations in the two groups. The plasma concentrations were far below toxic levels. Only the time of plasma peak was earlier in the group with the larger volume, which was attributed to the larger area of diffusion of the vascular system in the plexus space.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Jul 1990
[An accidental motor blockade of the femoral nerve following a blockade of the lateral femoral cutaneous nerve].
One hundred fifty successful blockades of the lateral cutaneous nerve of the thigh according to the technique of Eriksson with 7-10 ml prilocaine 1% or bupivacaine 0.25% for meralgia paresthetica resulted unexpectedly in 4 cases of complete and 5 cases of partial motor block of the femoral nerve. The fully reversible paralysis or paresis of parts of the lower limb following blockade of the lateral cutaneous nerve of the thigh is explained as a partial 3-in-1 block.
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Regional-Anaesthesie · May 1990
Randomized Controlled Trial Comparative Study Clinical Trial[The equipotency of ropivacaine, bupivacaine and etidocaine].
Ropivacaine, congenerate to bupivacaine and mepivacaine has been widely studied in laboratory animals, but there have been few investigations of its efficacy in human epidural anesthesia and peripheral nerve blocks. The aim of this study was to compare the three long-acting local anesthetics (bupivacaine 0.75%, ropivacaine 1% and etidocaine 1%) and to try, with reference to previous studies, to make some statement about the equipotency of ropivacaine relative to bupivacaine and etidocaine. METHODS. ⋯ CONCLUSION. The results of this study indicate that ropivacaine is an effective local anesthetic agent. Its potency is about equal to that of bupivacaine and much higher than that of etidocaine...