Regional anesthesia
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Regional anesthesia · Mar 1992
Local anesthetic distribution in a spinal model: a possible mechanism of neurologic injury after continuous spinal anesthesia.
Cauda equina syndrome has been reported recently in patients receiving continuous spinal anesthesia using newly developed microcatheters (28 gauge). Failure of microcatheters to allow adequate mixing of local anesthetic was studied as a possible mechanism of the neurologic injury reported with these catheters. ⋯ Dependent drug concentrations were greater than those reported in the literature, capable of producing permanent neurologic injury. Directing the catheter tip in the nondependent direction and injecting lidocaine rapidly or through catheters with multiple end holes improved mixing and decreased dependent drug concentration.
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Regional anesthesia · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative epidural morphine, but not epidural bupivacaine, delays gastric emptying on the first day after cholecystectomy.
Gastric emptying is delayed during the first days after abdominal surgery. Studies with volunteers have shown that epidural morphine delays gastric emptying but epidural analgesia with bupivacaine does not. The aim of this study was to evaluate whether these differences in healthy volunteers are also found after cholecystectomy when epidural morphine or epidural bupivacaine is used for postoperative pain relief. ⋯ Postoperative gastric emptying was significantly delayed after epidural analgesia with morphine compared to thoracic epidural bupivacaine. Compared to the control situation, epidural bupivacaine did not influence gastric emptying.
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Though cervical paratracheal injections for the purpose of sympathetic block are customarily referred to as stellate ganglion blocks, there is no documentation of the actual site of local anesthetic action. The objective of this study is to test whether solution travels to the stellate ganglion during injections commonly used to anesthetize it. ⋯ The findings suggest that sympathetic neural block during stellate ganglion block may take place at sites other than the stellate ganglion.