Regional anesthesia
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Regional anesthesia · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialBrachial plexus block. A comparison of the supraclavicular lateral paravascular and axillary approaches.
Anesthesia of the brachial plexus has been associated with injuries to adjacent structures (e.g., pneumothorax, vascular penetration). It is not uncommon to have only partial block of the upper extremity, hindering completion of the surgical procedure. The supraclavicular lateral paravascular approach to brachial plexus anesthesia has been proposed as an effective, safe alternative to the traditional approaches to brachial plexus anesthesia. ⋯ The supraclavicular lateral paravascular approach is as effective as the axillary approach.
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Regional anesthesia · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialSubarachnoid morphine and fentanyl for labor analgesia. Efficacy and adverse effects.
The study was designed to compare analgesic efficacy and associated adverse effects between a group of parturients receiving subarachnoid opioids via the combined spinal-epidural (CSE) technique with a group receiving epidural analgesia alone for labor. ⋯ The combination of subarachnoid morphine 0.25 mg and fentanyl 25 micrograms, when used for labor analgesia as part of the CSE technique, was associated with a higher incidence of clinically significant nausea and vomiting and pruritus, compared to conventional epidural anesthesia. Furthermore, the combination of subarachnoid morphine and fentanyl proved ineffective in providing adequate pain relief for the duration of labor and delivery for the majority of patients. The authors recommend that subarachnoid morphine and fentanyl serve a limited role in the treatment of labor pain.
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Regional anesthesia · Jan 1994
Randomized Controlled Trial Clinical TrialDiluting lidocaine and mepivacaine in balanced salt solution reduces the pain of intradermal injection.
Intradermal injection of local anesthetics prior to percutaneous needle insertion is often painful. This study evaluated the effect of diluting lidocaine and mepivacaine with balanced salt solution on perception of pain on intradermal injection. ⋯ The dilution of lidocaine and mepivacaine with balanced salt solution produces a solution that is both painless on injection and of moderate duration.
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Regional anesthesia · Jan 1994
Case ReportsCombined spinal and epidural anesthesia for abdominal hysterectomy in a patient with myotonic dystrophy. Case report.
The authors report a case of myotonic dystrophy in a 34-year-old woman who presented for total abdominal hysterectomy. The goal of anesthetic management is to prevent the known triggers of myotonic crisis, such as hypothermia, shivering, and hyperkalemia; and to avoid depolarizing muscle relaxants and anticholinesterase agents. ⋯ After the postoperation, optimal analgesia was obtained by infusing local anesthetic (0.125% bupivacaine) via the epidural catheter. No obvious side effects occurred. The authors believe combined spinal and epidural block provides a safe alternative, to other techniques, and minimizes the potential hazards of myotonic dystrophy, while offering effective intraoperative anesthesia and postoperative analgesia.
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Regional anesthesia · Nov 1993
ReviewPhysiologic mechanisms by which local anesthetics may cause injury to nerve and spinal cord.
Review evidence for possible physiologic mechanisms by which local anesthetics cause nerve injury was reviewed. ⋯ In rare instances, the clinical use of local anesthetics is associated with neurologic morbidity. The physiologic mechanisms of toxicity for which there is the best evidence are inhibition of fast axonal transport, disruption of the axonal cytoskeleton, axonal degeneration, and ischemic nerve injury. The effects of local anesthetics on nerve blood flow may be related to inhibition of endothelium-dependent vasodilation or interruption of the synthesis of vasodilating prostaglandins. Both the prevention and the treatment of nerve injury caused by local anesthetics requires information that is not yet available about the physiologic and molecular mechanisms for direct neural toxicity of local anesthetics.