Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2003
Review Comparative StudyContinuous spinal anaesthesia: what's new and what's not.
Continuous spinal anaesthesia combines the advantages of single-dose spinal anaesthesia, rapid onset and a high degree of success, with those of a continuous technique. The introduction of micro-catheters invigorated interest in the technique and allowed its expansion to additional populations and surgical procedures. ⋯ From this perspective, continuous spinal anaesthesia remains a useful and safe technique. Future research should focus on the comparison of continuous spinal anaesthesia with the combined spinal/epidural technique and the use of newer spinal agents.
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Best Pract Res Clin Anaesthesiol · Sep 2003
Case Reports Comparative StudyIntrathecal neurolytic blocks for the relief of cancer pain.
Intrathecal neurolytic blocks for the treatment of chronic pain were first described by Dogliotti in 1931. Since then, many authors have described the intrathecal injection of various neurolytic substances for the treatment of oncologic pain. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. ⋯ Four cases of cancer patients whose intractable pain was treated by the authors using intrathecal neurolysis are presented. Pertinent literature is reviewed. In this account, the emphasis is on proper selection of patients and techniques.
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The use of spinal anaesthesia in children has been primarily limited to situations in which general anaesthesia was considered to pose an excessive risk. The ex-premature infant and the neurologically impaired child account for the majority of spinal anaesthetics used today. Spinal anaesthesia, compared with general anaesthesia, in the ex-premature infant undergoing inguinal hernia repair has decreased postoperative respiratory complications (e.g. apnoeic events, prolonged mechanical ventilation). ⋯ Advances in spinal needle design have decreased the incidence of postdural puncture headache (PDPH). Catastrophic events have occurred with neuraxial techniques. Care must be taken in evaluating the relative risks of anaesthetic approaches in infants and children.