Regional anesthesia
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Regional anesthesia · Mar 1991
An electronic device (Episensor) for detection of the interpleural space.
Complications associated with interpleural block are often related to difficulty with needle and catheter placement. Thus there exists need for refinement of the puncture technique. We present our initial experience identifying the interpleural space with a new electronic detector (Episensor, Palex, Spain) that is sensitive to negative pressure. ⋯ Pain relief during the 48-hour observation period was good. Supplemental analgesia was required in nine nephrectomy patients. We believe the Episensor may be a valuable adjunct to the initiation of interpleural anesthesia.
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Regional anesthesia · Mar 1991
Cardiovascular and central nervous system effects of co-administered lidocaine and bupivacaine in piglets.
The toxic profile of bupivacaine (1 mg/kg/minute) when administered intravenously alone or with lidocaine (1 mg/kg loading dose, then 1 mg/kg/minute) was examined in 12 2-day-old pigs anesthetized with 70% N2O/30% O2 and paralyzed with 0.15 mg/kg pancuronium. Bupivacaine doses producing arrhythmias, seizures, isoelectric EEG and asystole were about 24% lower in the lidocaine plus bupivacaine group (n = 6) than in the bupivacaine group (n = 6). However, the incidence of cardiac arrhythmias in the combination local anesthetic group (3/6) was half that in the bupivacaine group (6/6). Administration of lidocaine with bupivacaine under conditions of this study apparently reduces the risk of cardiac arrhythmias and acts along with bupivacaine to produce seizures, cerebral depression (isoelectric EEG) and asystole.
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Clinical TrialAnalgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain: a placebo controlled study.
The analgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain was studied. Lidocaine or placebo was infused intravenously in ten healthy volunteers on 2 separate days according to a double-blind, randomized, cross-over design. Analgesia was assessed by argon laser-induced sensory and pain thresholds and pain evoked potentials after doses of 0.7, 1.85 and 3.7 mg/kg of lidocaine, infused over 15, 45 and 75 minutes, respectively. ⋯ Although administration of the highest dose of lidocaine (mean plasma concentration, 8.5 mumol/l) caused significant increases in pain and sensory thresholds, the magnitude of these increases was no greater than those that occurred during placebo infusion. The power of the pain evoked potentials was significantly decreased by the highest dose of lidocaine (p = 0.0024) compared with placebo. These results probably reflect that the effect of lidocaine on subjective pain perception might be caused primarily by sedation.
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative pain treatment after open knee surgery: continuous lumbar plexus block with bupivacaine versus epidural morphine.
The anesthetic and side effects of a continuous lumbar plexus block ("3-in-1" block) were compared with that of epidurally administered morphine after open knee surgery. Twenty-two patients were randomized into two groups in this prospective, double-blind study. At the end of surgery, catheters were inserted for all the patients into both the femoral nerve sheath and the epidural space. ⋯ The pain scores and supplemental morphine consumption were low in both groups and did not differ significantly. Lumbar plexus block produced a statistically significant a lower incidence of nausea, vomiting, pruritus and urinary retention. Although no significant differences in pain relief were shown between the two methods, we conclude that postoperative lumbar plexus block is preferable for postoperative pain relief because there is a lower frequency of side effects.