Regional anesthesia
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Regional anesthesia · Sep 1993
Randomized Controlled Trial Comparative Study Clinical TrialFentanyl for epidural intravascular test dose in obstetrics.
Although dizziness and drowsiness may be produced with either intravenous or epidural fentanyl, their occurrence after an intravenous injection is more rapid and relatively more pronounced. The purpose of this study was to determine whether or not the difference between routes of administration would be a reliable method of detecting an accidental intravascular injection. ⋯ Overall, the responses to intravenous fentanyl (40/40) occurred in a remarkably more consistent fashion when compared to epidural fentanyl (2/40). Thus, the results suggest that in laboring patients, intravenous fentanyl produces predictable and easily detectable changes that may be useful in identifying an epidural catheter unintentionally placed intravascularly.
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Regional anesthesia · Sep 1993
Case ReportsEpidural blood patch improves postdural puncture headache in a patient with benign intracranial hypertension.
Benign intracranial hypertension (BIH) is a disorder of elevated resting intracranial pressure without associated intracranial abnormality. When medical therapy fails to halt visual impairments or recalcitrant headaches progress, lumbar dural puncture and cerebral spinal fluid (CSF) drainage procedures are instituted. The authors report on a patient with BIH in whom a severe postdural puncture headache (low CSF pressure syndrome) paradoxically developed after therapeutic CSF drainage. This postdural puncture headache was successfully treated with an epidural blood patch without complicating the patient's underlying BIH condition.
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Regional anesthesia · Sep 1993
Local myotoxicity of bupivacaine in rabbits after continuous supraclavicular brachial plexus block.
Local anesthetics including bupivacaine have been known to be myotoxic. Continuous brachial plexus blocks with bupivacaine provide good postoperative pain relief, but their effects on the surrounding muscles have not been studied. ⋯ Brachial plexus blocks with bupivacaine caused reversible myotoxicity and inflammation in the rabbit. A week after the continuous blocks, muscle fiber regeneration had already started.