Regional anesthesia
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Regional anesthesia · Nov 1996
Randomized Controlled Trial Clinical TrialLidocaine-clonidine retrobulbar block for cataract surgery in the elderly.
Clonidine, an alpha-2-adrenoreceptor agonist, has been shown to decrease intraocular pressure (IOP) and to have some analgesic and sedative effects when it is used in premedication for ophthalmic surgery. This study was designed to investigate the efficacy of lidocaine-clonidine retrobulbar block for cataract surgery with respect to its effect on IOP, analgesic action, and sedative effects. ⋯ Addition of clonidine to lidocaine for retrobulbar block causes a decrease in intraocular pressure, a sedative effect, and an increased duration of analgesia and akinesia, with relatively stable hemodynamic parameters.
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Regional anesthesia · Nov 1996
ReviewEpidural opioid delivery methods: bolus, continuous infusion, and patient-controlled epidural analgesia.
Multiple methods of delivery of epidural opioids are acceptable, including bolus injection, continuous infusion, and patient-controlled infusion. The incidence of side effects appears to be reduced with the use of continuous infusion techniques, especially with the liquid-soluble opioids, although these appear to be most effective when infused near the center of the dermatomal pain site. with more distant catheters, the water-soluble opioids are more effective, but there use is associated with more frequent side effects. The lowest dose requirement appears to be associated with PCEA, but further study is needed to confirm the theoretical safety and efficacy of this modality, especially if a constant background infusion is used along with the PCEA. At present, significant advantages appear to be obtainable by adding local anesthetic to the opioid infusion, but the ideal drug and dosage are yet to be determined.
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The expanded role for antiplatelet drugs and anticoagulant therapy has resulted in more surgical patients receiving these medications during the perioperative period. The risk of developing a spinal hematoma (epidural, subdural, or subarachnoid) remains exceedingly small in most patients despite receiving these therapies. Despite the low incidence, potentially devastating neurologic sequelae often occur in the patient who develops a spinal hematoma. ⋯ It remains extremely important that practitioners continue to report the occurrence of such hematomas, so that information can be gleaned from their experience. The experience of practitioners with LMWH and central neuraxial block, described above, currently is providing us with important information, which may ultimately affect the way we practice. Without case reporting of this information, the knowledge would remain unobtainable.