Regional anesthesia
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Regional anesthesia · Mar 1995
Case ReportsUnintentional subdural block during labor epidural in a parturient with prior Harrington rod insertion for scoliosis. Case report.
The authors report a case of unintentional subdural block in a parturient with prior Harrington rod insertion. ⋯ Lumbar epidural anesthesia is not always an easily performed technique and is known to be associated with a higher incidence of complications in patients with prior Harrington rod insertion. Prompt recognition and proper management of subdurally placed needle and catheter avoided more serious complications.
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Regional anesthesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialSpinal anesthesia for cesarean delivery. A comparison of two doses of hyperbaric bupivacaine.
Hyperbaric local anesthetic pools in the thoracic spinal curvature in supine patients. The authors hypothesized that patients receiving 12 or 15 mg of hyperbaric bupivacaine would achieve similar levels of sensory block but the spinal anesthetic would be denser and longer lasting in patients receiving the 15 mg dose. ⋯ Parturients receiving 15 mg of hyperbaric bupivacaine developed a higher mean level and longer duration of sensory analgesia than those receiving 12 mg.
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Regional anesthesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialAddition of bicarbonate to plain bupivacaine does not significantly alter the onset or duration of plexus anesthesia.
In an effort to elucidate further the effect of alkalinization of bupivacaine on its anesthetic effect, a study was undertaken using alkalinized and non-alkalinized bupivacaine for lumbar plexus block and comparing the results with those obtained previously with brachial plexus block. ⋯ The data obtained in the present study indicate that alkalinization of non-epinephrine-containing bupivacaine does not reduce the latency or increase the duration of analgesia or anesthesia after lumbar plexus block. Since most of the studies that do show such an effect of alkalinization were carried out using epinephrine-containing bupivacaine, it is postulated that in those studies alkalinization contributed to the decrease in latency and increase in duration, not so much by providing an increased amount of local anesthetic in the free base form, but by reactivating epinephrine's vasoconstrictor activity, which is inactivated by a low pH.
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Regional anesthesia · Mar 1995
Clinical TrialEpidural air injection assessed by transesophageal echocardiography.
The object of this study, using transesophageal echocardiography (TEE) in anesthetized patients, was to investigate the occurrence of venous air embolism (VAE) when air is injected into the epidural space. ⋯ No evidence of clinically significant VAE was seen in any patient. The results suggest that drugs injected into the epidural space may have unexpectedly easy access to the venous circulation with a potential to produce unwanted systemic effects. Clinicians should be alert to the possibility that local anesthetics, or any other drug placed epidurally, may rapidly enter the systemic circulation even without the intravenous placement of an epidural catheter.
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Regional anesthesia · Mar 1995
Clinical TrialCompartment block for foot surgery. A new approach to tibial nerve and common peroneal nerve block.
The concept of single injections of local anesthetics into fascial compartments was pioneered by Winnie in reports on paravascular techniques. Winnie described an axillary approach for brachial plexus block and the inguinal route for lumbar plexus block. The compartmental principle can, with advantage, be extended to more peripheral anesthesia of the tibial and common peroneal nerves by the use of osteofascial compartments in the leg. ⋯ Further studies of compartmental anesthesia for other nerve trunks and plexuses may be of value.