Articles: analgesia.
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Cervical epidural anaesthesia (CEA) is a method suitable for regional anaesthesia of the upper extremity. CEA seems useful for postoperative pain relief after surgery in the shoulder region or both upper extremities, especially when the postoperative pain relief must be long lasting (days), and when it is desirable that the patient be able to actively move his affected joints during rehabilitation. Potential side effects of the method are respiratory- and haemodynamic changes. Thus, CEA is inappropriate for patients with severe respiratory disease, and in patients for whom extensive sympathetic block may prove disastrous (e.g. congestive heart failure, hypovolaemia).
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Complications associated with epidural anaesthesia include accidental intravascular or subarachnoid epidural catheter misplacement resulting in systemic toxicity and total spinal block, respectively. Epidural test doses are used routinely to prevent these events. ⋯ The ability of the epidural test dose to detect subarachnoid injection remains unknown. Studies are needed to determine 1) the reliability of the epidural test dose among different groups of patients, 2) the safety of the test dose, and 3) the incidence of epidural catheter misplacements.
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Despite its efficacy, bupivacaine has never been considered to be the most suitable agent for achieving anaesthesia and analgesia in the obstetric patient. Ropivacaine is less cardiotoxic than bupivacaine and, at low concentrations, can produce analgesia with minimal motor block, attributes which make it potentially very suitable for use in obstetrics. However, further research is required to ultimately establish ropivacaine's place in obstetric anaesthesia and analgesia. Levobupivacaine, the L isomer of bupivacaine, is of similar potency to bupivacaine but has the advantage of being significantly less cardiotoxic than racemic bupivacaine, which suggests that it might ultimately replace racemic bupivacaine in obstetric practice.