Regional anesthesia
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To investigate whether and to what extent air bubbles are present in the epidural space after injections of air, the authors designed an experiment using a chronic dog model. The epidural space was entered at the sixth or seventh lumbar interspace in six mongrel dogs (weight, 20 to 27 kg). Loss-of-resistance (LOR) to saline was tested to identify the epidural space. ⋯ No air was seen on later films. The air bubbles seen were small and few in number but often located near intervertebral spaces. The authors' findings suggest that injection of large volumes of epidural air should be avoided, particularly when N2O is used as part of the anesthetic or when performing diagnostic peridurography since N2O may expand the volume of existing bubbles and interfere with filling of the epidural space by local anesthetics or contrast material.
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Regional anesthesia · Jul 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of continuous epidural analgesia with sufentanil and bupivacaine during and after thoracic surgery on the plasma cortisol concentration and pain relief.
The effect of continuous epidural analgesia with bupivacaine 0.125% and sufentanil 0.83 micrograms.ml-1 on the plasma cortisol concentration and postoperative pain relief was compared with that of intermittent intravenous peroperative and on-demand intramuscular postoperative analgesia with nicomorphine 0.2 mg.kg-1. The study was performed on two groups of ten patients for three consecutive days after thoracic surgery. In the epidural group, a better quality of analgesia was found as measured with the Inverse Linear Analgesia Scale (ILAS) (1 = severe pain, 10 = no pain) than in the group that received intramuscular analgesia. ⋯ L-1 on day 1. The measured mean plasma cortisol concentration was found to exceed normal limits (150-700 nmol. L-1) only in the systemic group and only on day 1.
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Spinal anesthesia with 0.5% glucose-free bupivacaine was given to 20 patients lying in the lateral decubitus position during lumbar injection and for 30 minutes after. The mean maximum level of anesthesia after 30 minutes was Th:8 in the nondependent side and Th:9 in the dependent side. ⋯ The degree of motor blockade also showed significant difference between the dependent and nondependent side except at five minutes. These findings indicate glucose-free bupivacaine 0.5% is hypobaric in clinical conditions.