Regional anesthesia
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Clinical TrialPostoperative pain relief in children from the parascalene injection technique.
Nineteen pediatric patients aged 6 months to 12 years scheduled for elective upper extremity surgery were randomly assigned to receive either a parascalene block or sham injection. Both groups received a potent inhalational agent for operative anesthesia. ⋯ Patients in the parascalene group had superior postoperative analgesia, as evidenced by significantly less opioid requirement in the first 12 postoperative hours and by significantly lower scores on an objective pain scale. We found the parascalene approach to the brachial plexus a simple and reliable analgesic technique in anesthetized children.
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative pain treatment after open knee surgery: continuous lumbar plexus block with bupivacaine versus epidural morphine.
The anesthetic and side effects of a continuous lumbar plexus block ("3-in-1" block) were compared with that of epidurally administered morphine after open knee surgery. Twenty-two patients were randomized into two groups in this prospective, double-blind study. At the end of surgery, catheters were inserted for all the patients into both the femoral nerve sheath and the epidural space. ⋯ The pain scores and supplemental morphine consumption were low in both groups and did not differ significantly. Lumbar plexus block produced a statistically significant a lower incidence of nausea, vomiting, pruritus and urinary retention. Although no significant differences in pain relief were shown between the two methods, we conclude that postoperative lumbar plexus block is preferable for postoperative pain relief because there is a lower frequency of side effects.
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Clinical TrialContinuous spinal anesthesia with hyperbaric bupivacaine: a dose-response analysis.
Continuous spinal anesthesia (CSA) with hyperbaric bupivacaine (0.75% bupivacaine in 8.25% dextrose and water) was administered to 27 adult males for transurethral endoscopic surgery. Patients were randomized to receive either 3.75, 7.5 or 10 mg hyperbaric bupivacaine in a double-blind fashion. A 20-gauge nylon catheter was inserted at the L3-4 interspace, via an 18-gauge Tuohy-Schliff needle, extending only 2 cm into the subarachnoid space. ⋯ The role of the subarachnoid catheter in the dispersion and distribution of bupivacaine within the subarachnoid space was studied in a model spinal canal system and compared with the distribution of bupivacaine administered via a standard 25-gauge spinal needle. No significant differences were found in the distribution of bupivacaine with either method of injection. The distribution of hyperbaric bupivacaine within the subarachnoid space appears to be related to baricity but is unrelated to administration via needle or catheter.
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Regional anesthesia · Jan 1991
Anatomic spread of india ink in the human intercostal space with radiographic correlation.
In a study designed to determine the spread of anesthetic solutions in the intercostal space, the spread of india ink was studied in fresh cadavers. They were turned prone and had epidural catheters placed at ribs 4, 6, 8 and 10, 7-8 cm lateral to the midline, by two different techniques. Group 1 had epidural catheters directed laterally into the subcostal groove. ⋯ Posteroanterior and lateral radiographs taken with contrast material in live patients confirmed these patterns of spread. The catheters in Groups 1 and 2 were within the same tissue plane. The results indicate that the pattern of spread obtained by injection of fluid in the intercostal space is dependent upon the site of injection in relation to the angle of the rib.
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Epidural abscess is a neurologic emergency. Diagnosis may be difficult and costly to patients and health care providers in terms of time and money expended. ⋯ Diagnostic studies were performed that documented the presence of a spinal epidural abscess. Routine aspiration of an implanted epidural catheter facilitated the early diagnosis of epidural abscess in our patient prior to the performance of these studies.