Regional anesthesia
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Regional anesthesia · Jul 1994
Comparative StudyProlonged analgesia with liposomal bupivacaine in a mouse model.
Currently available local anesthetics have relatively limited duration of action and some may cause severe systemic toxicity. An ultralong lasting local anesthetic would be useful to produce prolonged intraoperative anesthesia and extended postoperative analgesia. The goal of this study was to synthesize a sustained release local anesthetic formulation that would produce prolonged sensory block and decrease the possibility of systemic toxicity. ⋯ This study shows that liposomal encapsulation of bupivacaine significantly prolongs duration of action and greatly decreases systemic toxicity of the drug. These findings may be promising for the future production of formulations of ultralong lasting local anesthetics with enhanced efficacy and safety.
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Regional anesthesia · Jul 1994
Comparative Study Clinical TrialSurvey of opioid use in chronic nonmalignant pain patients.
Opioids have been accepted as appropriate treatment for acute and cancer pain, but remain controversial for use with chronic nonmalignant pain. Clinicians are concerned about efficacy, tolerance, addiction, and unwanted side effects. ⋯ The results suggest that chronic nonmalignant pain patients taking opioids for their pain reported some tolerance, fear of addiction, and side effects when taking opioids. However, despite these concerns, some of these patients felt that opioid therapy was very beneficial. Further investigations are needed to determine which patient characteristics predict benefit from opioid therapy for nonmalignant pain.
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Regional anesthesia · Jul 1994
Clinical TrialInfluence of the subarachnoid position of microcatheters on onset of analgesia and dose of plain bupivacaine 0.5% in continuous spinal anesthesia.
Many factors have an impact on the outcome of continuous spinal anesthesia (CSA) with small-bore catheters. Recent publications of neurologic complications after CSA suggest that the local anesthetic as well as the microspinal catheter influence the analgesic effect in CSA. This prospective study was designed to evaluate the influence of the subarachnoid position of 28-gauge spinal catheters on the speed of onset of analgesia and on the dose of plain bupivacaine 0.5% required for a block at the level of T-10 in CSA. ⋯ The subarachnoid position of a 28-gauge microcatheter is an important factor with regard to the effectiveness (e.g., onset time of analgesia and dose requirement) of CSA using plain bupivacaine 0.5%.
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Regional anesthesia · Jul 1994
Clinical TrialSubarachnoid microcatheter anesthesia in small children.
Standard single dose spinal anesthesia is a recognized technique for neonates and small children. The advent of the subarachnoid microcatheter technique potentially expands the use of spinal anesthesia. The authors studied the use of repeated neuroblock via spinal catheters in 10 children under 5 years, undergoing major abdominal surgery of 2 hours or longer. ⋯ The technique was a very effective method of providing adjunct operative anesthesia in infants and small children. Analgesia, muscle relaxation, and cardiovascular stability were present and no complications arose besides the apparent cerebrospinal fluid leak. The resultant risk of infection or possible duracutaneous fistula formation contraindicates the use of subarachnoid catheters of 28 gauge for postoperative analgesic use in young children.