Regional anesthesia
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Regional anesthesia · Nov 1992
Comparative StudyThoracic paravertebral block in chronic postoperative pain.
Chronic postoperative pain in thoracic dermatomes is common. The most frequently used methods of pain relief in this area are posterior multidermatomal intercostal nerve or thoracic epidural blocks. Compared with these methods, thoracic paravertebral block may have some advantages. Usually only one injection is needed, and the use of larger volumes of local anesthetic (up to 25 ml) results in widespread unilateral analgesia including sympathetic block without the potential risk of hypotension and motor block associated with epidural block. ⋯ Thoracic paravertebral block proved to be a reliable and safe technique for unilateral pain relief in chronic post-thoracotomy pain.
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Regional anesthesia · Nov 1992
Case ReportsWhen to remove an epidural catheter in a parturient with disseminated intravascular coagulation.
Pain from labor and delivery is often attenuated with epidural anesthesia. A complication of indwelling epidural catheters is intraspinal hematoma. The development of a bleeding diathesis can worsen complications markedly. ⋯ Frequent assessment of neurologic status is important until the underlying cause of the coagulopathy can be treated and the bleeding resolves. If there is no indication of intraspinal bleeding, we recommend removing the catheter because of potential catheter migration. If bleeding is occurring around the catheter insertion site and possibly in the epidural or subarachnoid space, the catheter may be left in place to tamponade the insertion site. In cases of intraspinal hematoma, which can cause neurologic deficits, immediate decompression surgery is needed.
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Regional anesthesia · Sep 1992
Randomized Controlled Trial Clinical TrialPerioperative analgesia with subarachnoid sufentanil administration.
Thirty-seven ASA Physical Status I parturients undergoing elective cesarean delivery were evaluated to determine the effects of subarachnoid sufentanil administration. ⋯ Duration of complete analgesia and duration of effective analgesia were prolonged significantly in all patient groups receiving sufentanil as compared to control groups receiving no narcotic. Pruritus was significantly increased in patient groups receiving subarachnoid sufentanil. Respiratory depression was not observed in any patient studied. One- and five-minute Apgar scores; umbilical, venous, and arterial blood gas results; and Early Neonatal Neurobehavioral Scale results were all within normal limits and were not significantly different among the groups.
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Regional anesthesia · Sep 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of Sprotte and Quincke needles with respect to post dural puncture headache and backache.
The objective of this study was to compare 24-gauge Sprotte and 25-gauge Quincke needles with respect to post dural puncture headache and backache. ⋯ Our data indicate that Quincke needles should not be used with the needle bevel inserted perpendicular to the dural fibers. The Sprotte needle does not solve the problem of post dural puncture headache and backache.
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Regional anesthesia · Sep 1992
Case ReportsSelective block of nerves in the axillary approach to the brachial plexus.
Optimal surgical conditions for flexor tendon tenolysis in the hand were achieved by ulnar, radial, and musculocutaneous nerve block at the axilla combined with median nerve block at the wrist. ⋯ Palpation of nerves together with a nerve stimulator were used to localize the nerves accurately.