Anesthesiology and pain medicine
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Opioid analgesics are commonly added to epidural local anesthetics to improve analgesia during surgery. ⋯ The addition of tramadol to epidural 2% lidocaine offers advantages in cesarean section.
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Intentional lowering of blood pressure helps to produce a desirably clean surgical field. Many drugs can be used to induce a hypotensive state, but due to their high potency and rapid effect, drugs that more easily and safely control the induction of hypotension are desirable. ⋯ Premedication with oral clonidine can improve the hemodynamic management of cesarean cases.
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Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH. ⋯ There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males.