Regional anesthesia
-
Regional anesthesia · Sep 1991
Case ReportsPost dural puncture headache after lumbar sympathetic block: a report of two cases.
Dural puncture during lumbar sympathetic block (LSB) is a recognized but apparently uncommon complication. Interestingly, post dural puncture headache (PDPH) has not been reported as a complication of LSB. ⋯ In the second case the patient developed PDPH and a subdural block during separate LSBs. Possible anatomic explanations for these complications are discussed.
-
Regional anesthesia · Sep 1991
Case ReportsBlood pressure, not heart rate, as a marker of intravascular injection of epinephrine in an epidural test dose.
Investigators have generally examined the heart rate response after injection of a test dose containing a beta-adrenergic agonist as an indicator of intravascular placement of an epidural catheter. Some have reported an increase in blood pressure accompanying the increase in heart rate after an intravascular injection. ⋯ As far as we know, this phenomenon previously has been described only in patients receiving beta-adrenergic blocking drugs. In these patients it may be related to decreased beta-adrenergic receptor responsiveness in elderly patients; this and other possible mechanisms are discussed.
-
Twenty consecutive patients requiring surgical procedures on a lower extremity received leg blocks using a modification of Labat's classic approach. A Doppler ultrasound pencil probe was used to identify the dominant arterial structure exiting the sciatic notch with the sciatic nerve. A block needle was inserted in the same orientation as the probe until paraesthesias were elicited; then 25 ml of local anesthetic was injected. Successful block was achieved in one or two attempts in 70% of the patients.
-
Regional anesthesia · Sep 1991
Randomized Controlled Trial Clinical TrialEpidural butorphanol augments lidocaine sensory anesthesia during labor.
To determine the efficacy and safety of epidural butorphanol combined with lidocaine, 50 healthy parturients were studied during labor and delivery. All patients received a test dose of 3 ml 1.5% lidocaine with 1:200,000 epinephrine. Patients were then randomly assigned to receive 7 ml of one of two epidural regimens in a double-blind fashion: Group 1 patients received 1.5% lidocaine plus 1 mg butorphanol plus 1:300,000 epinephrine; Group 2 patients received 1.5% lidocaine plus 1:300,000 epinephrine. ⋯ There were no difference between groups in duration of first and second stages of labor, method of delivery or neonatal outcome. Umbilical cord acid-base status and neurologic adaptive capacity scores did not differ significantly between the two groups. The authors conclude that adding small doses of butorphanol to epidural lidocaine during labor is effective and safe.
-
Regional anesthesia · Sep 1991
Popliteal sciatic nerve block aided by a nerve stimulator: a reliable technique for foot and ankle surgery.
The reliability of popliteal sciatic nerve blocks was prospectively assessed in 625 blocks performed in 507 patients. The sciatic nerve was approached at the apex of the popliteal fossa, in the midline, with an insulated needle connected to a peripheral nerve stimulator partially designed by one of the authors. When needed, an inguinal paravascular femoral nerve block was also performed. ⋯ Overall satisfaction with perioperative analgesia was evaluated by 466 patients: 444 (95%) were completely satisfied, 20 (4%) expressed moderate reservations and two (1%) expressed major reservations. The authors conclude that the technique is a safe and reliable alternative to more common forms of anesthesia for surgery below the knee. They attribute the great success rate to a high popliteal approach, the use of insulated needles, a discriminating mode of nerve stimulation and the systematic search for optimal response to needle stimulation.