Regional anesthesia
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Regional anesthesia · May 1991
Comparative StudyAnalgesia after cesarean delivery: patient evaluations and costs of five opioid techniques.
The study was designed to compare five opioid analgesic regimens administered after cesarean delivery in a routine hospital setting with respect to patients' perceptions of their pain relief and the impact of analgesic technique on recovery and hospital costs. After cesarean delivery, 684 patients received one of the following: epidural morphine, alone (EM,n = 128), or with fentanyl (EM + F,n = 245); subarachnoid morphine (n = 48); intramuscular meperidine (n = 165), or patient-controlled analgesia using meperidine (PCA, n = 98). On the first three postoperative days (Days 1-3; day of operation is Day 1) patients were surveyed regarding their impressions of their analgesia, the incidence of side effects, times to resume normal activities and satisfaction with their technique. ⋯ Other aspects of recovery did not differ among the groups. Satisfaction parallelled pain relief and was better with intraspinal than with systemic opioids. Costs were greatest with PCA, although differences were small (less than 1%) relative to total hospital charges.
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Regional anesthesia · May 1991
The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: a prospective study of 856 cases.
In an effort to determine the incidence of respiratory depression and other side effects of subarachnoid morphine, we conducted the following prospective study in a large number (856) of young female patients undergoing cesarean delivery in one hospital. During the period from July 1987 to January 1989, patients receiving subarachnoid hyperbaric bupivacaine combined with 0.2 mg preservative-free morphine were included. They were continuously monitored for 24 hours using a pulse oximeter. ⋯ Eighty-five percent of the patients were satisfied with the postoperative analgesia. Six percent were dissatisfied due to the side effects, i.e., pruritus, nausea and/or vomiting. Nine percent were dissatisfied with the pulse oximeter because it caused false alarms and limited their mobility.
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Regional anesthesia · May 1991
Sensory analgesia for vaginal deliveries: a preliminary report of continuous spinal anesthesia with a 32-gauge catheter.
Our initial experience in providing pain relief during labor and delivery for 20 parturients using a 32-gauge continuous spinal microcatheter using 1% lidocaine is described. The technique significantly reduced the pain of labor, which was assessed as severe by 18 of the patients, and provided adequate perineal anesthesia for vaginal delivery with 18 patients indicating pain during delivery to be minimal. ⋯ Technical difficulty was the main disadvantage with the use of the 32-gauge microcatheter. An inability to thread the catheter (two patients) through the 26-gauge spinal needle or kinking of the catheter (two patients) making injection impossible, and unintentional catheter removal (one patient) resulted in a 25% failure rate with this technique.
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Regional anesthesia · May 1991
Spinal anesthesia for cesarean delivery with dilute solutions of plain bupivacaine: the relationship between infused volume and spread.
In a prospective open study, 40 women received spinal anesthesia for cesarean delivery induced with 15 mg glucose-free bupivacaine administered in dilutions of 0.5% (3 ml), 0.25% (6 ml), 0.125% (12 ml) and 0.083% (18 ml). The solutions were infused over 30 minutes while the women lay in the right lateral decubitus. No clinical or statistical difference in the final level of block was observed between the groups. ⋯ At the end of the infusion period when the women were turned from the lateral decubitus to a supine tilted position, there was a sudden rise in the levels of block on both sides of the body such that, by ten minutes after turning, there was no discernible difference between the two sides. The final block levels attained were within the expected range for conventional spinal anesthesia using 2.5-3.0-ml glucose-free 0.5% bupivacaine. The findings suggest that the subarachnoid spread of isobaric/hypobaric spinal anesthetic drugs is a complex process unlikely to be explained by reference to simple models of the spinal curves.