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
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.
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The volume of epidural local anesthetic required to achieve a particular dermatomal sensory level varies significantly between patients. Studies have demonstrated random cephalad or caudad migration and direction of the epidural catheter. However, no studies have investigated the relationship between catheter direction and total volume of local anesthetic. ⋯ The authors conclude that epidural catheter direction influences the total dose of local anesthetic required to achieve a specific sensory level in epidural anesthesia.