Regional anesthesia
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialIntercostal nerve block for minor breast surgery.
Two anesthetic procedures, intercostal nerve block (ICNB) and general anesthesia, were evaluated in 45 female patients scheduled for minor breast surgery. The study was designed to compare ICNB with general anesthesia for breast surgery with respect to efficacy, surgical stress and postoperative analgesia and to evaluate epinephrine and ornipressin as vasoconstrictors in the local anesthetic solution. Thirty patients received ICNB of T3-T7 unilaterally using 2% lidocaine plus epinephrine (15 patients, Group A) and 2% lidocaine plus ornipressin (15 patients, Group B). ⋯ Before and during surgery, epinephrine and norepinephrine plasma levels were highest in the epinephrine group, whereas, postoperatively, the plasma levels of both catecholamines were highest in the patients receiving general anesthesia. The latter patients experienced significantly more nausea and vomiting than the regional anesthesia groups. Patients with regional anesthesia required significantly less analgesics postoperatively than the patients receiving general anesthesia.
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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.