Regional anesthesia
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Regional anesthesia · Jul 1990
Comparative StudyLaser-induced pain for quantitative comparison of intravenous regional anesthesia using saline, morphine, lidocaine, or prilocaine.
The significance of ischemia-producing intravenous regional anesthesia (IVRA) was investigated using isotonic saline for injection. The possible analgesic effect of morphine was tested by injecting 40 ml morphine hydrochloride 0.01% for IVRA. Analgesia was evaluated subjectively by measuring the thresholds (warmth and pain) to laser stimulation and objectively by measuring the brain potentials (amplitude and latency) evoked by brief laser stimuli. ⋯ After the deflation of the cuff, the thresholds and the brain potentials recovered rapidly. No differences in the efficacy of lidocaine or prilocaine were observed. It is concluded that 30 minutes of tourniquet application is sufficient to cause analgesia and that morphine does not provide more adequate analgesia than saline when used for IVRA.
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Regional anesthesia · Jul 1990
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 0.75% ropivacaine with epinephrine and 0.75% bupivacaine with epinephrine in lumbar epidural anesthesia.
Forty-three ASA physical status I and II patients, scheduled for elective urologic surgery, were randomly entered into a randomized double-blind study using 20 ml bupivacaine 0.75% or 20 ml ropivacaine 0.75%, both with 5 micrograms/ml epinephrine. Two patients were excluded from evaluation of efficacy due to technical failure. After a test dose of 3 ml bupivacaine 0.75% with epinephrine or ropivacaine 0.75% with epinephrine, 17 ml of either solution was given in incremental doses over 4 minutes (4, 4, 4, and 5 ml). ⋯ No postoperative adverse events related to anesthesia were observed. Ropivacaine 0.75% with epinephrine is an effective long-acting local anesthetic. Duration of sensory block is similar to that of bupivacaine 0.75% with epinephrine; however, the motor block is less profound and of shorter duration.
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Regional anesthesia · Jul 1990
Biography Historical Article1990 Labat lecture. Pain relief: fact or fancy?
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Regional anesthesia · Jul 1990
Randomized Controlled Trial Comparative Study Clinical TrialLidocaine hydrocarbonate is not superior to lidocaine hydrochloride in interscalene brachial plexus block.
To determine the effect of carbonation of lidocaine, a comparison of 1.0% lidocaine hydrochloride (HCl) and 1.1% lidocaine hydrocarbonate (CO2), both with 1:200,000 epinephrine, was made in this study of 50 patients receiving interscalene brachial plexus blocks. Sensory block was determined by the response to pinprick in the C2-T2 dermatomes, while motor block was assessed by the development of paresis and paralysis at the shoulder and hand. The percentage of patients developing analgesia (decreased sensation to pinprick) and anesthesia (total absence of sensation to pinprick) at each dermatome level as well as the percentage of patients developing motor block was not significantly different between the two forms of lidocaine. ⋯ At the individual dermatomes, there was no difference in the onset of analgesia except at one dermatome level, C7, which was near the level of local anesthetic injection. Anesthesia onset in each dermatome as well as the onset of motor block did not differ between the two groups. It is concluded that lidocaine CO2 does not offer any significant clinical advantage over lidocaine HCl in interscalene brachial plexus block.
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Regional anesthesia · Jul 1990
Randomized Controlled Trial Comparative Study Clinical TrialEffects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine.
This study was designed to determine whether clonidine has analgesic properties, decreases the minimum alveolar concentration of inhalational anesthetics, or affects the quality and the duration of spinal anesthesia with bupivacaine. The comparative effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine were studied in 36 patients scheduled for orthopedic surgery. ⋯ Subarachnoid but not oral clonidine significantly prolonged the duration of sensory block (time for regression to L2 was 157 +/- 21 minutes in Group I and 267 +/- 75 minutes in Group II) and the duration of motor block (duration of Grade 3 motor block--Bromage scale--was 103 +/- 20 minutes in Group I and 175 +/- 68 minutes in Group II). Only the subarachnoid administration of clonidine achieves adequate concentrations to significantly increase the duration of spinal anesthesia.