Regional anesthesia
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Regional anesthesia · Nov 1995
Comparative StudyComparison of thrombelastography with common coagulation tests in preeclamptic and healthy parturients.
Epidural analgesia/anesthesia is often beneficial in the management and treatment of preeclampsia. However, some preeclamptic patients have a coagulopathy that is a contraindication to regional anesthesia. A routine coagulation battery (RCB) consisting of prothrombin time, partial thromboplastin time, platelet count, and bleeding time, is commonly performed to assess coagulation status. Thrombelastography (TEG) is a measure of clotting that allows evaluation of overall coagulation activity. The goal of this study was to examine whether TEG can predict normal and abnormal coagulation as diagnosed by RCB in healthy and preeclamptic parturients. ⋯ Thrombelastography is not an effective means of predicting abnormal coagulation, as diagnosed by RCB, in preeclamptic parturients, using currently defined normal TEG values for nonpregnant patients. However, an abnormal TEG maximum amplitude value always correlated with a prolonged bleeding time. Therefore, TEG may be useful in assessing platelet function in the presence of thrombocytopenia. Further studies are warranted.
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Regional anesthesia · Nov 1995
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of the abdominal wall relaxation produced by epidural 0.75% ropivacaine and 0.75% bupivacaine in gynecologic surgery.
Ropivacaine is a long-acting local anesthetic agent with similar potency to that of bupivacaine when administered for epidural anesthesia. Ropivacaine, however, may be less cardiotoxic than bupivacaine. Epidural bupivacaine and ropivacaine have been shown to be equally effective in providing sensory block for lower extremity surgery, but they have not been compared for their ability to produce abdominal wall relaxation. ⋯ Both 0.75% ropivacaine and 0.75% bupivacaine provide adequate surgical anesthesia for lower abdominal surgery when administered epidurally. However, lower extremity motor block with ropivacaine is significantly shorter and of slower onset and sensory block shorter at these concentrations.
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Regional anesthesia · Nov 1995
Comparative Study Clinical Trial Controlled Clinical TrialImpact of patient-controlled analgesia on required nursing time and duration of postoperative recovery.
Patient-controlled analgesia (PCA) offers effective postoperative pain management. However, the evidence of economic benefits associated with its use is lacking. Although suggestive, the potential economic advantages of PCA in saving nursing time and shortening hospital stay need objective documentation. ⋯ Data in this study have demonstrated some beneficial effects of PCA on nursing time requirements when it was used following cholecystectomy and lumbar laminectomy at the University of Toronto: however, the magnitude of these benefits was less than previously reported. The effects of PCA on postoperative recovery and hospital stay, however, were not significantly different from i.m. therapy.
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Regional anesthesia · Nov 1995
Randomized Controlled Trial Comparative Study Clinical TrialInfluence of baricity on the outcome of spinal anesthesia with bupivacaine for lumbar spine surgery.
Although the majority of elective lumbar spine surgical procedures are performed under general anesthesia, successful use of spinal and epidural anesthesia has been reported. This study was designed to evaluate the influence of baricity on the performance of spinal anesthesia for lumbar spine surgery. ⋯ Plain bupivacaine is superior to hyperbaric bupivacaine for spinal anesthesia for elective lumbar spine surgery.
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Regional anesthesia · Nov 1995
Clinical TrialArea of paresthesia as determinant of sensory block in axillary brachial plexus block.
Paresthesia is widely considered a useful indicator for locating components of the brachial plexus using the axillary approach. While establishing axillary brachial plexus blocks, the authors attempted to correlate the area of paresthesia with the effectiveness of the sensory block. ⋯ Eliciting paresthesia at the nerve supplying the area of a planned surgical incision is a reliable determinant of successful axillary brachial plexus block.