Cogliano MS, Graham AC, Clark VA

Simpson Memorial Maternity Pavilion, Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW, UK.

[Medline record in process]

We investigated the necessity for administration of supplementary oxygen to mothers undergoing elective Caesarean section under spinal anaesthesia. Sixty-nine women undergoing elective Caesarean section were randomly allocated to one of three groups to be given either oxygen (40%) by facemask, air by facemask or oxygen at 2 l x min(-1) by nasal cannulae. Umbilical arterial and venous blood samples were taken and analysed immediately after delivery. The results showed that there were no significant differences in the umbilical arterial or venous pH, partial pressure of oxygen and partial pressure of carbon dioxide between any of the three groups. We also assessed the patient acceptability of oxygen administered by facemask vs. nasal cannulae should the need for supplementary oxygen arise. It was found that use of the facemask impeded communication.

PMID: 11843746, UI: 21832535

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Anaesthesia 2002 Jan;57(1):15-20

Maternal cardiovascular consequences of positioning after spinal anaesthesia for Caesarean section: left 15 degree table tilt vs. left lateral.

Rees SG, Thurlow JA, Gardner IC, Scrutton MJ, Kinsella SM

Department of Anaesthesia, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK. sgorees@tuatara2.demon.co.uk

[Medline record in process]

Sixty healthy women undergoing elective Caesarean section were randomly allocated to either a measured 15 degrees left table tilt u position (n = 31) or full left lateral position (n = 29) for a 15-min period after spinal blockade. Arm and leg blood pressure, ephedrine requirements, symptoms, fetal heart rate, cord gases and Apgar scores were recorded. Mean ephedrine requirements and incidence of hypotension were similar in the two groups. Arm systolic arterial pressure over time was similar in both groups, but leg systolic arterial pressure over time was significantly lower in the tilt group (p < 0.001); the mean leg systolic arterial pressure was lower for all 15 sequential recordings in the tilt group, reaching statistical significance (p < 0.05) at 4, 5, 6 and 8 min. Differences in maternal nausea, vomiting and bradycardia and fetal outcome were not statistically significant. Following spinal anaesthesia, even a true 15 degrees left table tilt position is associated with aortic compression.

PMID: 11843736, UI: 21832525

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Anaesthesia 2002 Jan;57(1):4-8

Glycopyrronium and hypotension following combined spinal-epidural anaesthesia for elective Caesarean section in women with relative bradycardia.

Rucklidge MW, Durbridge J, Barnes PK, Yentis SM

Magill Department of Anaesthesia, Intensive Care & Pain Management, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.

[Medline record in process]

The ability of glycopyrronium to reduce the severity of hypotension following subarachnoid block in parturients with a relative bradycardia was evaluated in a double-blind randomised controlled study. Women with a resting heart rate of < or = 80 beat x min(-1) presenting for elective Caesarean section were randomly allocated to receive either glycopyrronium 2 microg x kg(-1) or normal saline intravenously u once positioned for combined spinal-epidural anaesthesia. Following spinal injection of 2.6 ml hyperbaric bupivacaine 0.5% and fentanyl 15 microg, women randomly allocated to the saline group were given 6 mg ephedrine so that all parturients received some prophylaxis against hypotension other than the fluid preload. Further ephedrine and fluid boluses were administered if mean arterial pressure fell 20% or more from resting values. Using a sequential analysis technique, analysis after the first 20 subjects indicated the study should be stopped, with no difference in ephedrine requirements or hypotension between the groups. We conclude that pretreatment with glycopyrronium 2 microg x kg(-1) is no more effective than 6 mg ephedrine in preventing hypotension following subarachnoid block in parturients with relatively low resting heart rates.

PMID: 11843734, UI: 21832523

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):113

Phantom position under upper limb block and assessment of success.

Gentili ME, Bonnet F, Bernard JM, Maxoit JX

Publication Types:

• Letter

PMID: 11799521, UI: 21657659

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):111-2

More on the use of near-infrared spectroscopy to evaluate stellate ganglion block.

Quaresima V, Ferrari M

Publication Types:

• Letter

PMID: 11799519, UI: 21657657

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):110-1

Postoperative apnea uin a former preterm infant: clonidine or too much unbound bupivacaine?

Pirotte T, Veyckemans F

Publication Types:

• Letter

PMID: 11799517, UI: 21657655

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):105-8

Opioid-free analgesia following total knee arthroplasty--a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac.

Horlocker TT, Hebl JR, Kinney MA, Cabanela ME

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. horlocker.terese@mayo.edu

BACKGROUND AND OBJECTIVES: Traditionally, postoperative analgesia following total knee arthroplasty (TKA) has been provided by neuraxial or peripheral regional techniques with supplemental administration of opioids. We report an alternative method of postoperative pain management for patients undergoing TKA in whom the use of systemic or neuraxial opioids may result in significant side effects. CASE REPORT: A 74-year-old woman with a history of protracted nausea and vomiting after systemic and neuraxial opioid administration presented for left total knee arthroplasty. A spinal anesthetic with postoperative continuous lumbar plexus (psoas) analgesia was planned. A quadriceps motor response was elicited and a 20-gauge catheter was advanced through an 18-gauge insulated Tuohy needle into the psoas sheath. After 30 mL of bupivacaine 0.5% with 100 microg clonidine was administered through the psoas catheter, a spinal anesthetic (2 mL 0.5% bupivacaine at the L2-3 interspace) was performed. A continuous psoas infusion of 0.2% bupivacaine with 2 microg/mL clonidine at 8 mL/h was initiated in the recovery room. The psoas infusion was subsequently changed u to 0.2% bupivacaine without clonidine and the rate increased to 10 mL/h. Supplemental analgesia with oral acetaminophen 1 g every 4 to 6 hours alternating with intravenous ketorolac 15 mg every 6 hours provided satisfactory analgesia, with visual analog scale (VAS) scores of 0 to 2 at rest and 3 to 4 with movement. The psoas catheter was removed 48 hours postoperatively because of prolongation of the prothrombin time. VAS scores remained 0 to 3 throughout the remainder of her hospitalization. CONCLUSION: A multimodal approach consisting of continuous lumbar plexus (psoas) block and nonopioid analgesics successfully provided postoperative pain relief in our patient and facilitated her physical rehabilitation after total knee arthroplasty.

PMID: 11799514, UI: 21657652

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):100-4

A portable mechanical pump providing over four days of patient-controlled analgesia by perineural infusion at home.

Ilfeld BM, Enneking FK

Department of Anesthesiology, University of Florida, Gainesville, Florida, USA. ilfelbm@anest1.anest.ufl.edu

BACKGROUND AND OBJECTIVES: Local anesthetics infused via perineural catheters postoperatively decrease opioid use and side effects while improving analgesia. However, the infusion pumps described for outpatients have been limited by several factors, including the following: limited local anesthetic reservoir volume, fixed infusion rate, and inability to provide patient-controlled doses of local anesthetic in combination with a continuous infusion. We describe a patient undergoing open rotator cuff repair who was discharged home with an interscalene perineural catheter and a mechanical infusion pump that allowed a variable rate of continuous infusion, a us well as patient-controlled boluses of local anesthetic for over 4 days. CASE REPORT: A 77-year-old woman, who had previously required a 3-day hospital admission for acute postoperative pain following an open repair of her left rotator cuff, presented for an open repair of her contralateral rotator cuff. Preoperatively she received an interscalene block and perineural catheter. After the procedure she was discharged home with a portable pump that infused ropivacaine continuously at a rate of 6 mL/h and allowed a 2-mL patient-controlled bolus every 20 minutes (550-mL reservoir). The basal infusion was decreased, as tolerated, by having the patient reprogram the pump with instructions given over the telephone. Without the use of any oral opioids, the patient scored her surgical pain 0 to 1 (on a scale of 0 to 10) while at rest and 2 to 3 for 2 physical therapy sessions during which she used the bolus function to reinforce her analgesia. After 98 hours of infusion, the patient's husband removed the catheter with instructions given over the telephone, and her subsequent surgical pain was treated with oral opioids. CONCLUSION: Continuous, perineural local anesthetic infusions are possible on an ambulatory basis for multiple days using a portable, programmable pump that provides a variable basal infusion rate, patient-controlled boluses, and a large anesthetic reservoir.

PMID: 11799513, UI: 21657651

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):94-6

Hypoxia following interscalene block.

Rose M, Ness TJ

Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.

BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block is often used for surgeries involving the sh uoulder and upper arm. Known complications include phrenic nerve paralysis, intravascular injection, and cervical epidural block. We report a patient who developed acute hypoxia immediately following this block, presumably secondary to an acute pulmonary thromboembolus (PTE) coupled with phrenic nerve paralysis. CASE REPORT: A 43-year-old man with end-stage renal disease secondary to hypertension was scheduled for primary placement of a left upper extremity arteriovenous fistula. A technically unremarkable interscalene brachial plexus block was performed using a 22-gauge regional block needle and 35 mL of 1.5% mepivacaine. Immediately following injection, the patient's oxygen saturation decreased from 99% to 85%, and he complained of chest pain and shortness of breath and developed hemoptysis. Workup revealed an elevated hemidiaphragm, but no pneumothorax or evidence of local trauma. A spiral computed tomogram (CT) suggested acute pulmonary thromboemboli as the etiology of the hypoxia and hemoptysis, although the diagnosis was uncertain. CONCLUSIONS: This case report suggests that manipulations and vasodilation related to an interscalene block may have facilitated the dislodgement of a pre-existing upper extremity thrombus.

PMID: 11799511, UI: 21657649

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):72-6

The subdural compartment.

Ajar AH, Rathmell JP, Mukherji SK

Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.

PMID: 11799508, UI: 21657646

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):43-6

Hypnosis increases heat detectio un and heat pain thresholds in healthy volunteers.

Langlade A, Jussiau C, Lamonerie L, Marret E, Bonnet F

Anesthetic Department and Pain Clinic, Tenon Hospital, Assistance Publique Hopitaux de Paris, Paris, France.

BACKGROUND AND OBJECTIVES: Hypnosis has been reported to induce analgesia and to facilitate anesthesia. To date, hypnotic-induced analgesia has had little explanation and it has even been questioned. The current study was thus designed to investigate the effect of hypnotic suggestion on thermal-detection thresholds, heat pain, and heat-pain tolerance thresholds. METHODS: In 15 healthy volunteers, enrolled in a randomized cross-over study, thermal thresholds were investigated in 2 sequences of measurements, under waking and hypnotic states, using a thermal stimulator. RESULTS: Heat detection and heat-pain thresholds were increased under hypnosis (from 34.3 +/-.9 degrees C to 36.0 +/- 2.9 degrees C and 45.0 +/- 3.7 degrees C to 46.7 +/- 2.7 degrees C, respectively, P <.05), whereas heat-pain tolerance and cold-detection thresholds were not statistically changed. CONCLUSION: These results indicate that hypnosis may partly impair the detection of A delta and C fibers stimulation, potentially explaining its analgesic effect.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11799504, UI: 21657642

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):1-2

Regional training circa 2000: What's really new.

Brown DL, Boezaart A

Publication Types:

• Comment
• Editorial

PMID: 11799496, UI: 21657634