Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Feb 2007
Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia.
Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. ⋯ Both techniques are effective and safe for labor analgesia, although the combined technique provided fast and immediate pain relief. Clinical studies with a larger number of patients are necessary to evaluate the differences in the incidence of cesarean sections.
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Rev Bras Anestesiol · Feb 2007
Epidural S+ ketamine and S+ ketamine-morphine associated with ropivacaine in the postoperative analgesia and sedation of upper abdominal surgery.
The association of drugs with different mechanisms of action in the dorsal horn of the spinal cord decreases postoperative pain, with a reduction in the incidence of side effects. The aim of this study was to evaluate postoperative analgesia and sedation by epidural S(+) ketamine and S(+) ketamine-morphine associated with ropivacaine in subcostal cholecystectomy. ⋯ S(+) ketamine and the associations S(+) ketamine-morphine promoted sedation up to 2h after the end of the surgical procedure. S(+) ketamine promoted analgesia especially at the moment of the 2h observation, and the associations of S(+) ketamine-morphine promoted analgesia especially at 2h and 6h after the surgery.
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Rev Bras Anestesiol · Feb 2007
Assessment of oral S+ ketamine associated with morphine for the treatment of oncologic pain.
Morphine is used frequently to treat oncologic pain. However, tolerance may develop with prolonged use. The association of a NMDA receptor antagonist may reduce or delay the onset of tolerance. S(+) ketamine seems to be more potent and with fewer side effects. The aim of this study was to evaluate the association of S(+) ketamine and morphine in the treatment of oncologic pain. ⋯ We did not observe an increase on the analgesic effects of morphine with the association of 10 mg of S(+) ketamine PO in the treatment of oncologic pain.
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Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. ⋯ The steps for a successful regional block include the identification of the exact position of the nerves, the precise localization of the needle, without causing injuries to adjacent structures, and, finally, the careful administration of the local anesthetic close to the nerves. Although neurostimulation is very useful in identifying nerves, it does not fulfill all those requirements. Therefore, it is believed that ultrasound-guided nerve blocks will be the technique of choice in regional anesthesia in a not too distant future.
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Rev Bras Anestesiol · Feb 2007
Influence of procainamide on the neuromuscular blockade caused by rocuronium and investigation on the mechanism of action of procainamide on the neuromuscular junction.
It has already been proved that procainamide potentiates the neuromuscular blockade of d-tubocurarine; however, the mechanism of this potentiation is controversial. The aim of this study was to assess the influence of procainamide on the neuromuscular blockade produced by rocuronium and investigate the mechanisms of this interaction. ⋯ Procainamide potentiated the blockade caused by rocuronium. The changes observed with MEPP and Biventer cervicis identified pre-synaptic action. The antagonism of 4-aminopiridine on the blockade of the MEPP suggested receptor desensitization by procainamide.