Regional anesthesia
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Regional anesthesia · Nov 1997
ReviewDoes epidural analgesia during labor affect the incidence of cesarean delivery?
There is substantial evidence that there is an increased incidence of cesarean delivery among patients who receive epidural analgesia during labor. The controversy as to whether there is a causal relationship between epidural analgesia and cesarean delivery. Two prospective, randomized studies suggest that epidural analgesia may increase the incidence of operative delivery in laboring women. ⋯ It is important to consider the impact of epidural analgesia on the total population of obstetric patients. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate. Finally, physicians should remember that pain relief is itself a worthy goal.
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Regional anesthesia · Nov 1997
Clinical TrialNeurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer.
Neurolytic superior hypogastric plexus block has been shown to be safe and effective in selected cancer patients. A large cohort of patients was studied to evaluate the continued efficacy and safety of this block in cancer patients with advanced disease. ⋯ Neurolytic superior hypogastric plexus block provided both effective pain relief and a significant reduction in opioid usage (43%) in 72% of the patients who received a neurolytic block. Overall, this represents 51% of the patients enrolled in the study. Poor results should be expected in patients with extensive retroperitoneal disease overlying the plexus because of inadequate spread of the neurolytic agent.
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Regional anesthesia · Nov 1997
Randomized Controlled Trial Comparative Study Clinical TrialIncidence of genitofemoral nerve block during lumbar sympathetic block: comparison of two lumbar injection sites.
Genitofemoral nerve (GFN) block is a known side effect of a lumbar sympathetic block (LSB), although the incidence has not been well documented. Furthermore, genitofemoral neuralgia can occur following neurolytic LSB. Because the level at which the GFN exits the psoas sheath varies, this study was designed to identify differences in the incidence of GFN block following LSB at the level of the second versus the fourth lumbar vertebrae. ⋯ The GFN is less likely to be blocked when the LSB is performed near the second lumbar vertebra as compared with the fourth lumbar vertebra.
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Regional anesthesia · Nov 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of postanesthetic sequelae after clinical use of 27-gauge cutting and noncutting spinal needles.
The tips of the bevels of thin spinal needles may be easily damaged by bony contact during puncture attempts. In this respect and also because they are less traumatic by design, noncutting, pencil-point-tip needles may be beneficial. A prospective clinical comparison of postanesthetic effects of the use of 27G Quincke-type and pencil-point spinal needles was therefore performed. ⋯ Postanesthetic sequelae, including postdural puncture headache (overall incidence 2.5%), were not related to the shape of the spinal needles or to the damage of the Quincke-type needles.
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Regional anesthesia · Nov 1997
Randomized Controlled Trial Clinical TrialSingle-shot spinal anesthesia with small doses of bupivacaine.
The potential risks of spinal lidocaine have generated interest in an alternative local anesthetic solution. Features of anesthetic block were therefore assessed in a double-blind randomized prospective study following administration of spinal bupivacaine in small doses. ⋯ Hyperbaric bupivacaine 6-8 mg provides a suitable alternative to spinal lidocaine for surgical procedures of short duration.