Regional anesthesia
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Regional anesthesia · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialVentilatory function and continuous high thoracic epidural administration of bupivacaine with sufentanil intravenously or epidurally: a double-blind comparison.
Variables of ventilation were obtained preoperatively and during the first two postoperative days in 28 patients after thoracic surgery. All patients received 0.5% bupivacaine with epinephrine, 5 micrograms.ml-1 (5-10 ml), through an epidural catheter at the thoracic level supplemented by light general anesthesia. One hour after the initial dose of bupivacaine, patients were randomly allocated to one of two groups: an epidural (EP) sufentanil and an intravenous (IV) sufentanil group. ⋯ The incidence of side effects was not different. Only the initial mean sufentanil plasma levels in patients of the IV group were higher than those of the EP group. This study shows that the variables of ventilation were not affected by sufentanil administered via the epidural or the intravenous route, and that both techniques provided excellent pain relief when employed to supplement low-dose 0.125% bupivacaine epidurally.
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Regional anesthesia · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialNalbuphine pretreatment in cesarean section patients receiving epidural morphine.
A double-blind, placebo-controlled study of 60 patients post cesarean delivery was conducted to determine whether nalbuphine reverses the side effects of pruritus and respiratory depression associated with epidurally administered morphine. Patients randomly received either three doses of intravenous nalbuphine or the equivalent volume of saline. Vital signs, sedation, pain, pruritus and oxygen saturation were assessed hourly for 18 hours. ⋯ Five patients had respiratory depression (respiratory rate lower than 10 BPM or oxygen saturation less than 90%); three occurred in the nalbuphine group and two in the saline group. Although theoretically advantageous, nalbuphine, as administered in this study of obstetric patients, offered no prophylactic benefit against the pruritus associated with epidural morphine. Its benefit with regard to respiratory depression remains unclear.
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Complications during spinal anesthesia were studied prospectively in 1881 patients. Twenty-six percent of the patients suffered from one or more complications. The most common complications were hypotension (16.4%) and bradycardia (8.9%). ⋯ Higher peak sensory level significantly increased the risk for hypotension (p less than 0.0001), bradycardia (p less than 0.0001) and nausea (p less than 0.0001). Female patients suffered significantly more hypotension (p less than 0.001), nausea (p less than 0.001) and vomiting (p less than 0.001) than males. Cementation of prosthesis and deflation of the leg tourniquet were other risk factors demonstrated in this study.
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Regional anesthesia · Mar 1991
An electronic device (Episensor) for detection of the interpleural space.
Complications associated with interpleural block are often related to difficulty with needle and catheter placement. Thus there exists need for refinement of the puncture technique. We present our initial experience identifying the interpleural space with a new electronic detector (Episensor, Palex, Spain) that is sensitive to negative pressure. ⋯ Pain relief during the 48-hour observation period was good. Supplemental analgesia was required in nine nephrectomy patients. We believe the Episensor may be a valuable adjunct to the initiation of interpleural anesthesia.