Regional anesthesia
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Regional anesthesia · Sep 1989
The subjective complications and efficiency of the epidural blood patch in the treatment of postdural puncture headache.
The complications and efficacy of epidural blood patch were studied retrospectively by means of a questionnaire sent to 236 patients. Hospital records were also studied. ⋯ Epidural blood patch was found to be effective; 84.5% of the respondents had complete and permanent recovery from headache in less than 24 hours after a single epidural blood patch. Of those responding, 42.3% were willing to undergo spinal anesthesia in the future, when indicated, only if they could be assured of getting epidural blood patch in the event of a postdural puncture headache.
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Regional anesthesia · Sep 1989
Randomized Controlled Trial Clinical TrialAlkalinization of epidural 0.5% bupivacaine for cesarean section.
Controversial results have been published in the literature concerning the efficacy of alkalinization of solutions of local anesthetics to shorten the time to onset of sensory block. Fifty-two parturients scheduled for cesarean section at term under epidural anesthesia were randomly allocated to one of four groups: group 1, 0.5% plain bupivacaine (pH = 5.38 +/- 0.05); group 2, 0.5% bupivacaine pH-adjusted with 1.4% sodium bicarbonate (pH = 6.87 +/- 0.01); group 3, 0.5% bupivacaine with 1:200,000 epinephrine (pH = 4.80 +/- 0.04); and group 4, 0.5% bupivacaine pH-adjusted with 1:200,000 epinephrine (pH = 6.68 +/- 0.01). The time to onset of the sensory block was evaluated using a nerve stimulator technique. ⋯ No differences in the characteristics of the onset of the sensory block were observed with epinephrine-containing solutions nor with pH-adjusted local anesthetics. The maximal degree of motor blockade was not significantly different in the four groups. We conclude that alkalinization of a 0.5% bupivacaine solution is not an effective way to shorten the latency of epidural block for cesarean section.
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Regional anesthesia · Sep 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of pH adjustment of 0.5% bupivacaine on the latency of epidural anesthesia.
pH adjustment of lidocaine and 2-chloroprocaine has been reported to decrease the latency of epidural anesthesia (EA). The effect of alkalinization of bupivacaine on onset of surgical anesthesia has not been adequately studied to date. To determine what effect raising the pH of 0.5% bupivacaine has on the latency of EA in patients undergoing lower extremity surgery, we performed a randomized, double-blind study. ⋯ The pH of the LA used for Group I was 6.96 +/- 0.01 and for Group II was 5.33 +/- 0.11. No statistically significant difference was found between the anesthetic parameters tested in each group. On this basis, we find no advantage of pH adjustment of 0.5% bupivacaine for EA.
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Six groups of ten women each in active labor at term had epidural catheters placed in the usual manner and received a 3 mL test dose of 2% lidocaine with epinephrine. Groups 1-6 received, respectively, 5, 10, 20, 30, 40 and 50 micrograms of sufentanil diluted to 10 mL with normal saline. Significantly effective analgesia was provided at all sufentanil doses studied, with pain scores decreasing from 8.1 +/- 0.2 at baseline to 2.9 +/- 0.3 at 10 minutes and 1.1 +/- 0.2 at 30 minutes (mean +/- SEM, average for all groups). ⋯ There were no serious maternal side effects, although ten patients developed pruritus, four became dizzy, two experienced mild sedation, and one had transient hypotension. No neonatal side effects occurred. Maternal serum sufentanil levels remained below the sensitivity of the assay, or 0.1 ng/ml.
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Regional anesthesia · Sep 1989
Comparative StudyBupivacaine/butorphanol/epinephrine for epidural anesthesia in obstetrics: maternal and neonatal effects.
The effects of epidural bupivacaine/butorphanol with and without 1:300,000 epinephrine on maternal analgesia, uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid base status and the neurologic and adaptive capacity scores (NACS) were compared in 33 parturients during labor and delivery. Patients in Group I (n = 17) received 0.25% bupivacaine plus 1 mg butorphanol plus 1:300,000 epinephrine, and those in Group II (n = 16) received the same agents without the epinephrine. Addition of epinephrine to bupivacaine/butorphanol did not have any adverse effects on uterine activity, duration of first or second stages of labor or fetal heart rate parameters. ⋯ Apgar scores, neonatal acid base status and the NACS were equally good and did not differ significantly between the two groups. Duration of analgesia was significantly longer in Group I as compared to Group II patients (177.5 +/- 11 versus 131.8 +/- 10 minutes, p less than 0.01). It is concluded that addition of epinephrine 1:300,000 to bupivacaine/butorphanol during epidural anesthesia in the normal parturient has no adverse effects on the mother, fetus or neonate or on the progress of labor and it significantly prolongs the duration of analgesia.