Regional anesthesia
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Regional anesthesia · Jul 1991
Comparative StudyTechnical complications during long-term subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases.
The type and incidence of technical complications (e.g., obstruction and dislocation of the catheter and infection) in long-term (ten to 366 days) spinal morphine administration in terminally ill cancer patients by means of an epidural or subarachnoid catheter are presented. Total treatment time was 8650 days, of which patients spent 6175 at home. Portable external mini infusion pumps were used with satisfactory results in 15 patients of the epidural group (n = 110) and in all patients receiving subarachnoid morphine (n = 30). ⋯ In patients receiving subarachnoid morphine, the prevalent complication was CSF leakage, which was observed only during the first two weeks of treatment. The subarachnoid route is preferred for patients expected to live longer than one month. For patients with a shorter life expectancy, epidural administration can yield acceptable results.
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Regional anesthesia · Jul 1991
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of postcesarean epidural morphine analgesia by single injection and by continuous infusion.
To assess the relative efficacy and incidence of side effects of a single injection versus a continuous infusion of epidural morphine sulfate (MS) in the postcesarean population, the authors report a prospective, randomized, double-blind study. Thirty-one patients received either a 5-mg MS bolus and subsequent saline infusion (n = 13) or a 2.6-mg MS bolus and subsequent MS infusion at 0.1 mg/hour (n = 18), such that after 24 hours both groups had received a total MS dose of 5 mg. ⋯ The authors conclude that in this population, continuous epidural morphine infusion offers no obvious advantage over single morphine bolus therapy. However, the theoretical merits of continuous opioid infusion therapy are discussed.
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Regional anesthesia · Jul 1991
Back pain after epidural anesthesia with chloroprocaine in volunteers: preliminary report.
The incidence, character and treatment of backache associated with epidural anesthesia (EA) using 3% chloroprocaine (2-CP, Nesacaine-MPF) were observed in ten volunteers undergoing a study of the effects of EA upon plasma catecholamines. Three levels of epidural analgesia were sequentially sought, T10, T4 and C8, in ascending order. Each block was allowed to fully dissipate prior to the next injection. ⋯ Mean verbal analog scale pain scores after regression of the first, second and third blocks were 2.2, 4.3 and 6.5, respectively. Epidural fentanyl (100-200 micrograms) was effective in providing rapid relief of the pain. Large doses or possibly repeated injections of epidural Nesacaine-MPF are associated with an increased incidence and severity of postanesthesia lumbar back pain.
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Regional anesthesia · Jul 1991
Randomized Controlled Trial Clinical TrialIntravenous lidocaine does not cause shivering-like tremor or alter thermoregulation.
We tested the hypotheses that systemic absorption of epidural lidocaine: (1) contributes to the shivering-like tremor seen during epidural anesthesia by causing central nervous system disinhibition of spinal reflexes, or (2) activates or alters thermoregulatory mechanisms. In a double-blind, placebo, cross-over study, nine healthy volunteers were given intravenous lidocaine (or saline) to approximate the plasma levels of lidocaine achieved during epidural anesthesia for major abdominal surgery. ⋯ Central temperatures, peripheral vasoconstriction, tremor and clonus were unaffected by intravenous lidocaine. We conclude that the systemic absorption of epidural lidocaine does not contribute to tremor or shivering by these mechanisms.
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Regional anesthesia · Jul 1991
Randomized Controlled Trial Comparative Study Clinical TrialComparison of onset time between 0.5% bupivacaine and 3% 2-chloroprocaine with and without 75 micrograms fentanyl.
We tested the hypothesis that the addition of 75 micrograms fentanyl to 0.5% bupivacaine would reduce the onset time of surgical anesthesia for cesarean delivery to equal the onset time of 3% 2-chloroprocaine and would have no effect when added to 3% 2-chloroprocaine. Fentanyl was found to reduce the onset time of bupivacaine to equal the onset time of 2-chloroprocaine and have no effect when added to 2-chloroprocaine.