Regional anesthesia
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Regional anesthesia · Mar 1993
Randomized Controlled Trial Comparative Study Clinical TrialThe characteristics of analgesic requirements following subarachnoid diamorphine in patients undergoing total hip replacement.
The postoperative pain scores and analgesic requirements were assessed in 60 patients who had undergone total hip replacement under bupivacaine spinal anesthesia. ⋯ Pain control after intrathecal diamorphine supplemented by intravenous morphine from a patient controlled analgesia system is superior to intravenous morphine alone.
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Regional anesthesia · Mar 1993
Randomized Controlled Trial Clinical TrialProlonged placement of spinal catheters does not prevent postdural puncture headache.
To determine whether leaving an intrathecal catheter in place in the postoperative period prevents postdural puncture headache (PDPH). ⋯ Leaving the intrathecal catheter in place in the postoperative period for 12 to 24 hours does not prevent PDPH.
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Regional anesthesia · Mar 1993
Review1992 Bonica Lecture. Advances in chronic pain management since gate control.
Two pain treatment systems that developed soon after the publication of the gate theory are probably a direct result of its publication: neuraxial opiate administration and electrical stimulation of the spinal cord and peripheral nerves and receptors. Although the use of these modalities has become widespread in managing chronic pain, there is disagreement about their long-term efficacy. This presentation will attempt to review the data regarding the mechanisms of action of these modalities and their efficacy in treating chronic pain of malignant and nonmalignant origin. ⋯ Long-term spinal opiate administration has been shown to be more effective than systemic opiates in some patients with cancer pain, but often must be combined with local anesthetics to provide satisfactory pain relief. Loss of effect over time is a significant problem. Since the identification of spinal opiate receptors and the introduction of spinally administered narcotics, a number of other receptors that are important in both sensitization and suppression of pain projection systems have been characterized. Agonists and antagonists to many of these receptors are being developed, and a few are available for clinical trials. Long-term electrical stimulation of the spinal cord produces substantial analgesia below the stimulated spinal segments in some patients with chronic pain. Although initial results are usually encouraging, long-term efficacy may be disappointing. It is postulated that analgesia associated with spinal stimulation is associated with both stimulation of large fiber ascending tracts and blockade of spinothalamic pathways. Transcutaneous electrical nerve stimulation (TENS) has come into widespread use in managing chronic pain and has had limited trials in cancer pain patients. It is well accepted by patients and physicians, but clinical studies of long-term efficacy have yielded variable results. The analgesic action is probably the result of both large afferent fiber activation and blockade of peripheral nociceptors.
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Regional anesthesia · Mar 1993
Randomized Controlled Trial Clinical TrialThe effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function.
Continuous interscalene brachial plexus block with 0.25% bupivacaine decreases diaphragmatic motility and ventilatory function. The author studied the effects of 0.125% bupivacaine with and without fentanyl. ⋯ Use of 0.125% bupivacaine for continuous interscalene block did not prevent a deterioration of diaphragmatic motility and ventilatory function. Co-infusion of fentanyl did not significantly potentiate the block.
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Regional anesthesia · Mar 1993
Complications during spinal anesthesia for cesarean delivery: a clinical report of one year's experience.
To evaluate the incidence and causes of complications associated with spinal anesthesia for cesarean delivery. ⋯ Spinal anesthesia proved to be a safe, reliable, and rapid method of anesthesia for cesarean delivery, but, in view of a high incidence of minor complications, careful patient monitoring during spinal anesthesia is necessary to make the outcome optimal for mother and fetus.