Regional anesthesia
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Clinical TrialTemperature changes and shivering after epidural anesthesia for cesarean section.
Changes in bladder, tympanic membrane, and skin temperature were monitored in two groups of parturients after they received epidural anesthesia for elective Cesarean sections. Group 2 patients (n = 21) received warm intravenous crystalloid and prep solutions as well as extra body covering, whereas Group 1 patients (n = 19) did not. ⋯ The peak onset of shivering occurred within 10 minutes of epidural anesthesia and preceded any significant decline in core temperature. However, a positive correlation was noted between shivering and bladder temperature decline over the full course of Cesarean section.
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialTreatment of shivering after epidural lidocaine.
The effectiveness of intravenous meperidine and warm local anesthetic for prevention of postanesthetic shivering was evaluated in urology patients undergoing epidural blockade for extracorporeal shockwave lithotripsy. When administered before the blockade, meperidine, 12.5 mg or 25 mg, was not significantly better than saline placebo for preventing postepidural shivering. ⋯ The authors concluded that neither meperidine, in doses employed, nor body-temperature lidocaine prevents shivering after epidural blockade. This shivering appears to be different from that observed during emergence from general anesthesia.
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe treatment of patients with multiple rib fractures using continuous thoracic epidural narcotic infusion.
The incidence of tracheostomy, length of intensive care unit (ICU) and total hospital stay, and duration of ventilatory support were evaluated prospectively in 28 patients who had multiple rib fractures. The patients were randomly divided into two groups: 13 patients were given standard morphine parenteral analgesia and constituted the control group (Group 1), and 15 patients had thoracic epidural catheter placement within 72 hours from the time of admission to the ICU (Group 2). ⋯ Group 2 patients also had a lower incidence of tracheostomy versus control patients (6.7 +/- 6.7% vs. 38.5 +/- 14.0%, p less than 0.05). The authors believe that continuous thoracic epidural morphine analgesia may provide distinct pulmonary and economic advantages in patients with multiple rib fractures.
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Regional anesthesia · Jan 1989
ReviewASRA lecture 1988. The changing role of the anesthesiologist in pain management.
Changing concepts of pain mechanisms deemphasize the somatic aspects of chronic pain and enhance the concept that chronic pain is primarily a psychological disorder. As such, interruption of straight-through pain pathways through nerve blocking may not always be the treatment of choice. Evidence is given encouraging anesthesiologists to modify their thinking on the value of nerve blocks in the treatment of chronic pain and direct their efforts to the management of acute, postoperative, and cancer pain problems.
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Regional anesthesia · Jan 1989
Randomized Controlled Trial Clinical TrialThe effect of rate of infusion on continuous epidural analgesia for labor and delivery.
The authors previously reported that if a loading dose of 50 mg bupivacaine was followed by infusion of 0.0625% bupivacaine (12.5 mg/hr), supplemental doses to achieve satisfactory analgesia for labor and delivery were required in 50% of patients. The current study was done to determine whether increasing the dose from 12.5 to 25 mg/h would eliminate the need for supplemental injections. Twenty-three healthy parturients were randomly assigned to one of two groups--Group I: 0.125% bupivacaine at 20 ml/hr (25 mg/hr); or Group II: 0.25% bupivacaine at 10 ml/hr (25 mg/hr). ⋯ Pharmacokinetic data were similar in both groups. Using a dose of 25 mg/hr resulted in 74% of the patients obtaining adequate analgesia for labor and delivery. This improvement over the 50% success rate in the previous study, was achieved without any evidence of toxicity.