Regional anesthesia
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Regional anesthesia · Mar 1989
A two-person technique for epidural needle placement and medication infusion.
Traditional techniques of epidural needle placement have not proved satisfactory in patients who have had a previous laminectomy and may have epiduroarachnoiditis. A two-person technique was developed to: 1) simplify performance of difficult, epidural needle placement; 2) allow both resident and staff a simultaneous "hands-on" teaching experience; 3) allow a painless method of medication administration in patients with altered epidural anatomy; and 4) allow a simple method for determination of epidural space pressures. A glass syringe and extension tubing filled with saline are connected to the epidural needle. ⋯ The column of saline falls and fluctuates with heart beat, providing verification of correct needle placement. Medication is placed in the barrel of the syringe and allowed to infuse by gravity. The two-person technique has achieved both patient and resident acceptance, and allows a painless method of medication administration in patients with altered epidural space anatomy.
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Four local or regional anesthesia techniques for the insertion of cardiac pacemaker were studied prospectively in 40 patients. The four techniques studied were: local anesthesia, field block of the supraclavicular nerves, interscalene block at C4, and interscalene block at C6. The three goals of the study were to find the technique that gave the best quality of analgesia, the incidence of complications related to each technique, and the area of sensory innervation of C4. ⋯ Interscalene blocks at C4 and C6 were associated with complications and side effects more often than the two other techniques. The authors also suggest that the dermatome of C4 is not under the clavicle but above the clavicle. It was concluded that local anesthesia infiltration at the site of cardiac pacemaker insertion or field block of the supraclavicular nerves are the best techniques for cardiac pacemaker insertion.
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Regional anesthesia · Mar 1989
A retrospective analysis of neurolytic celiac plexus block for nonpancreatic intra-abdominal cancer pain.
Neurolytic celiac plexus block (NCPB) has been reported to be an effective method for pain relief for a variety of intra-abdominal malignancies, especially pancreatic. In spite of this, few data exist concerning efficacy of the block for pain related to other intraabdominal tumors. ⋯ The incidence of neurologic injury (footdrop) was less than 0.5%. This therapy deserves more widespread use in patients with abdominal pain secondary to a variety of other malignancies, in addition to that of the pancreas.
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Regional anesthesia · Jan 1989
Epidural and spinal anesthesia do not influence gastric emptying and small intestinal transit in volunteers.
The influence of thoracic epidural anesthesia, spinal anesthesia, and a painful stimulus on gastric emptying, orocecal transit time, and small intestinal transit were studied in nine healthy volunteers. Gastric emptying was measured by the acetaminophen absorption method. Orocecal transit time was determined by measuring end-expiratory hydrogen concentration. ⋯ Cold pain stress in itself did not influence gastric emptying, orocecal transit time, or small intestinal transit. Neither did epidural or spinal anesthesia during cold pain stress influence these variables of gastrointestinal motility. Thus, low spinal anesthesia or thoracic epidural anesthesia in itself did not influence gastric emptying, orocecal transit, or small intestinal transit.