Articles: analgesia.
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Spinal epidural abscess usually arises by hematogenous, lymphatic or venous spread. The frequent use of invasive procedures at the spinal cord such as epidural injections to produce analgesia has led to an increased incidence of iatrogenic abscesses. We describe 8 patients who developed iatrogenic spinal epidural abscesses after paravertebral or intragluteal punctures respectively intravenous catheters to produce analgesia. ⋯ Outcome was excellent with early therapy consisting of laminectomy and/or antibiotic treatment in the six patients treated within two days of appearance of symptoms. Invasive procedures at the spinal cord can lead to iatrogenic spinal epidural abscesses. Physicians dealing with deep punctures and catheter procedures should be aware of early symptoms and signs of an epidural abscess, since early diagnosis and specific therapy are the most important factors for a good outcome.
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Regional anesthesia · May 1997
Clinical TrialSingle-injection lumbar epidural morphine for postoperative analgesia in children: a report of 175 cases.
Since the first report of epidural opioid administration to pediatric patients, several studies have described the quality of analgesia, doses, pharmacokinetics, and side effects of this procedure. A pediatric series using an easy and cheap single-injection technique of epidural morphine administration for postoperative analgesia is presented. ⋯ This technique is easy to perform, even for trainees in anesthesiology. With appropriate patient selection and avoidance of the concomitant use of narcotics and sedatives, epidural morphine provides prompt, effective, safe, and prolonged analgesia in children.
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A case of complete uterine rupture during a trial of labour in which epidural analgesia was used is described. The pain of uterine rupture was not masked by the addition of fentanyl 25 micrograms to bupivacaine 0.25% 6 ml but was relieved by bupivacaine 0.375% 6 ml.
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Anesthesia and analgesia · May 1997
Randomized Controlled Trial Clinical TrialEffect on postoperative analgesia of small-dose lysine acetylsalicylate added to prilocaine during intravenous regional anesthesia.
Nonsteroidal antiinflammatory drugs act largely peripherally by blocking the local synthesis of prostaglandins. The aim of this study was to evaluate whether the addition of a small dose of lysine acetylsalicylate (LA) to the prilocaine used for intravenous regional anesthesia (IVRA) would improve the quality of postoperative analgesia. Sixty patients undergoing lower extremity IVRA for foot or ankle surgery were randomly assigned to three double-blind groups: LA-IVRA where 90 mg of LA was mixed with prilocaine 0.5% for IVRA and 1 mL of 0.9% NaCl administered intravenously (IV) through the forearm catheter after tourniquet inflation; LA-IV where 1 mL of 0.9% NaCl was mixed with prilocaine and 90 mg of LA administered IV; and placebo where 1 mL of 0.9% NaCl was administered both with prilocaine for the IVRA and IV. ⋯ Analgesic requirements remained significantly lower in LA-IVRA when compared with placebo only during the first six postoperative hours, LA-IV being in an intermediate position. Pain scores were significantly lower in LA-IVRA during the first postoperative hour when compared with LA-IV and during the first 3 postoperative hours when compared with placebo. We conclude that 90 mg of LA (corresponding to 50 mg of acetylsalicylic acid) added to prilocaine 0.5% during IVRA improves the quality of postoperative analgesia in the early postoperative period.
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Br J Obstet Gynaecol · May 1997
Blood pressure and fetal heart rate changes with patient-controlled combined spinal epidural analgesia while ambulating in labour.
To determine the effect of patient-controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour. ⋯ Patient-controlled epidural analgesia top-ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top-ups in the lying position.