Regional anesthesia
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Regional anesthesia · Jul 1991
Case ReportsHorner's syndrome after epidural block in early pregnancy.
Horner's syndrome after epidural block in a first-trimester parturient has not previously been reported. The authors describe a case of unilateral Horner's syndrome after single-dose epidural block in a 12-week pregnant female.
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In 100 pregnant women, identification of the epidural space was performed by a modified drip method. A saline infusion was prepared, leaving the distal 40 cm of infusion tubing full of air, and then attached to the hub of a Tuohy needle. ⋯ There were no unintentional dural punctures. This technique has advantages over the hanging drop and the manual loss of resistance techniques.
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Regional anesthesia · Jul 1991
Case ReportsLumbar epidural anesthesia initiated in the knee-chest position.
The knee-chest position may become necessary in labor to mitigate fetal heart rate decelerations. This position may also prove advantageous for initiation of lumbar epidural anesthesia. This case report demonstrates a clinical situation in which lumbar epidural anesthesia was initiated in the knee-chest position. A description of the technique is included.
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Regional anesthesia · May 1991
Comparative StudyAnalgesia after cesarean delivery: patient evaluations and costs of five opioid techniques.
The study was designed to compare five opioid analgesic regimens administered after cesarean delivery in a routine hospital setting with respect to patients' perceptions of their pain relief and the impact of analgesic technique on recovery and hospital costs. After cesarean delivery, 684 patients received one of the following: epidural morphine, alone (EM,n = 128), or with fentanyl (EM + F,n = 245); subarachnoid morphine (n = 48); intramuscular meperidine (n = 165), or patient-controlled analgesia using meperidine (PCA, n = 98). On the first three postoperative days (Days 1-3; day of operation is Day 1) patients were surveyed regarding their impressions of their analgesia, the incidence of side effects, times to resume normal activities and satisfaction with their technique. ⋯ Other aspects of recovery did not differ among the groups. Satisfaction parallelled pain relief and was better with intraspinal than with systemic opioids. Costs were greatest with PCA, although differences were small (less than 1%) relative to total hospital charges.