Regional anesthesia
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Regional anesthesia · Sep 1994
Randomized Controlled Trial Comparative Study Clinical TrialDifferential epidural block. Does the choice of local anesthetic matter?
It is well established that spinal anesthesia results in a differential block to the sensations of pinprick and cold temperature discrimination. However, the existence of differential block during epidural anesthesia has not always been accepted. Recently, it has been shown that lumbar epidural anesthesia with chloroprocaine and lidocaine produces a differential block to pinprick and cold sensation. The purpose of this study was to determine if the choice of local anesthetic used for epidural anesthesia has any influence on the relative levels of anesthesia, analgesia, and cold sensation. ⋯ This study reaffirms the existence of differential sensory block during epidural anesthesia and establishes that the observed differential block appears to be independent of the local anesthetic used.
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Regional anesthesia · Sep 1994
Comparative Study Clinical Trial Controlled Clinical TrialEpidural analgesia versus intravenous patient-controlled analgesia. Differences in the postoperative course of cancer patients.
This study evaluated 462 consecutive surgical cancer patients who underwent uncomplicated surgeries of the thorax or abdomen, or both, of more than 3 hours duration between 1989 and 1991. ⋯ The use of both analgesic techniques was associated with satisfactory postoperative pain control. However, patients receiving epidural anesthesia and analgesia experienced faster recovery as judged by shorter mechanical ventilation time, and decreased SICU and hospital stays, resulting in significantly lower hospitalization costs. The use of perioperative epidural techniques should be considered to expedite recovery of surgical patients, and has the added benefit of being cost effective by reducing hospital stays.
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Regional anesthesia · Sep 1994
Case ReportsColonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient.
A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids, and early oral feeding and mobilization. ⋯ The technique of combined neural and humoral mediator block should be evaluated in other high-risk patients undergoing major surgical procedures, where minimal invasive techniques are not possible.
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Regional anesthesia · Sep 1994
Clinical TrialDo patient variables influence the subarachnoid spread of hyperbaric lidocaine in the postpartum patient?
Age, height, weight, body mass index (weight/height2), and vertebral column length may affect the subarachnoid spread of local anesthetics. Little information exists concerning the relationship between these variables and the spread of hyperbaric lidocaine. The authors studied the influence of patient demographics on the block produced by hyperbaric lidocaine in women undergoing postpartum tubal ligation. ⋯ While height may have some small influence on the spread of sensory block, the variation in spread of block within patients of the same height is large. The data suggest that adjusting the dose of local anesthetic injected based on differences in patient height would provide no clinically significant benefit.