Regional anesthesia
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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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In 100 pregnant women, identification of the epidural space was performed by a modified drip method. A saline infusion was prepared, leaving the distal 40 cm of infusion tubing full of air, and then attached to the hub of a Tuohy needle. ⋯ There were no unintentional dural punctures. This technique has advantages over the hanging drop and the manual loss of resistance techniques.
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Regional anesthesia · Jul 1991
Case ReportsLumbar epidural anesthesia initiated in the knee-chest position.
The knee-chest position may become necessary in labor to mitigate fetal heart rate decelerations. This position may also prove advantageous for initiation of lumbar epidural anesthesia. This case report demonstrates a clinical situation in which lumbar epidural anesthesia was initiated in the knee-chest position. A description of the technique is included.