Regional anesthesia
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Regional anesthesia · Sep 1995
Randomized Controlled Trial Clinical TrialEpinephrine prolongs duration of subcutaneous infiltration of local anesthesia in a dose-related manner. Correlation with magnitude of vasoconstriction.
Epinephrine is frequently combined with local anesthesia to prolong analgesia. Determination of the minimal concentration and the dose of epinephrine that produces prolongation of analgesia is important in the face of epinephrine's potential for systemic and local toxicity. The authors undertook this study to determine a dose-response curve of epinephrine on duration of analgesia of both 1% lidocaine and 0.25% bupivacaine after local infiltration. In order to determine whether epinephrine-induced vasoconstriction affected duration of analgesia, the authors correlated duration of analgesia with magnitude of local vasoconstriction as measured with laser Doppler flowmetry. ⋯ Epinephrine prolongs duration of analgesia after local infiltration in a dose-related manner. Addition of epinephrine in concentrations of 1:50,000 or 1:200,000 increases duration of analgesia after local infiltration by approximately 200%. Addition of doses as dilute as 1:3,200,000 still increases duration of analgesia by approximately 100%. Duration of analgesia appears to correlate with magnitude of epinephrine-induced vasoconstriction using laser Doppler flowmetry. Based on study data, the use of epinephrine in concentrations from 1:200,000 to 1:3,200,000 is recommended for prolongation of analgesia after local infiltration.
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Regional anesthesia · Sep 1995
Randomized Controlled Trial Clinical TrialAlkalinization of local anesthetics. Which block, which local anesthetic?
A number of clinical studies have been performed in an attempt to establish the effects of alkalinization on potency of local anesthetics. Conflicting results were obtained probably because different studies used different methods as well as different definitions of the effects. To determine the efficacy of alkalinization using different local anesthetic solutions and different regional blocks, 180 patients were studied in a randomized, double-blind fashion. The local anesthetic solutions studied were bupivacaine, mepivacaine, and lidocaine; the regional blocks studied were epidural block, axillary brachial plexus block, and femoral and sciatic nerve block. ⋯ Alkalinization produced the best results with lidocaine and bupivacaine for epidural block, with lidocaine for brachial plexus block, and with mepivacaine for sciatic and femoral nerve blocks.
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Regional anesthesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of posture on the induction of epidural anesthesia for peripheral vascular surgery.
A study was done to determine whether a difference existed in the quality and time to maximum anesthesia between the induction of lumbar epidural anesthesia in the sitting and supine position in patients undergoing infrainguinal arterial reconstruction. ⋯ When lumbar epidural anesthesia was induced in the sitting rather than supine position, the time to maximum cephalad spread was shorter and correlated directly with the height and BSA of the patient. The position of the patient during induction had no effect on the final level of cephalad spread and degree of motor block.
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Regional anesthesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialThoracic versus lumbar administration of fentanyl using patient-controlled epidural after thoracotomy.
Epidural fentanyl injection can provide analgesia following thoracotomy, but where to insert the catheter is a matter of debate. The study compares the effects of thoracic and lumbar patient-controlled epidural fentanyl on analgesia, fentanyl requirements, and plasma levels after thoracotomy. ⋯ The authors concluded that there is little if any advantage of thoracic over lumbar patient-controlled epidural fentanyl administration in patients after thoracotomy with respect to analgesia, fentanyl requirements, and plasma levels.
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Regional anesthesia · Sep 1995
Randomized Controlled Trial Clinical TrialWrapping of the legs reduces the decrease in blood pressure following spinal anesthesia. A study in men undergoing urologic procedures.
Hypotension after induction of spinal anesthesia remains a common and a potentially serious complication despite acute expansion of intravascular volume. The current study evaluated the role of leg wrapping as an adjunct to acute volume expansion. ⋯ Tightly wrapping the legs with elastic bandages immediately after placing spinal anesthesia in mature men is a safe and efficient adjunct in preventing hypotension.