Regional anesthesia
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Regional anesthesia · Jan 1992
Randomized Controlled Trial Clinical TrialEffect of subarachnoid morphine on the incidence of spinal headache.
The addition of fentanyl to hyperbaric local anesthetics has been shown to reduce the incidence of post dural puncture headache in the obstetric patient. This study was undertaken to evaluate the effects of subarachnoid morphine on the incidence of headache. ⋯ It is concluded from our study that subarachnoid morphine did not decrease the incidence of post dural puncture headache in the obstetric patient.
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Loss of sensation to pinprick and cold are commonly used to test the extent of epidural anesthesia. To see what difference exists between the level of epidural block determined by various sensory modalities, we performed this study in ten volunteers using epidural anesthesia with plain 3% chloroprocaine hydrochloride. ⋯ This study establishes the existence of a differential epidural anesthesia during high thoracic block with chloroprocaine and suggests that the intensity of block diminishes as distance from site of injection increases.
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Regional anesthesia · Jan 1992
Venous levels of lidocaine and bupivacaine after midtarsal ankle block.
No data are available on blood levels of local anesthetics after ankle block. ⋯ The low peak level of local anesthesia and the prolonged analgesia confirmed the safety and efficacy of midtarsal ankle block for forefoot surgery and suggest that bupivacaine may be the local anesthetic agent of choice.
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Regional anesthesia · Jan 1992
Continuous epidural methadone for the management of postoperative pain after lower abdominal surgery.
The efficacy of methadone administered by continuous epidural infusion for 24 hours for the management of postoperative pain has been reported. The pharmacokinetic characteristics of methadone predict that significant accumulation would occur if infusions were continued for longer than 24 hours and that this accumulation could result in serum concentrations above the threshold associated with systemic analgesia. ⋯ The accumulation of serum concentrations reported here argue that the risks of thoracic epidural placement may outweigh the potential benefits when methadone is administered alone by continuous infusion for longer than 24 hours.
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Regional anesthesia · Jan 1992
Case ReportsBilateral subdural hematomas after dural puncture: delayed diagnosis after false negative computed tomography scan without contrast.
BACKGROUND. Dural puncture secondary to spinal anesthesia or unintentional dural puncture during attempted epidural anesthesia can lead to headaches complicated by bilateral subdural hematomas. ⋯ CONCLUSION. Computed tomography scans with contrast media or magnetic resonance imaging may be necessary to diagnose bilateral subdural hematomas.