Regional anesthesia最新文献

Background and objectives: Arachnoid cysts are a frequent finding on magnetic resonance imaging; however, the use of major conduction anesthesia in patients with these cysts has not been reported.

Methods: Epidural anesthesia was used in a parturient with a triplet pregnancy preeclampsia, and a documented arachnoid cyst extending from TII to LI.

Results: Epidural anesthesia was successfully used in this high-risk patient, and airway manipulation, which would have been difficult in this patient, was thereby avoided.

Conclusions: Arachnoid cysts are not a contraindication to major conduction anesthesia, as is confirmed by a review of arachnoid cysts and anesthetic considerations.

Background and objectives: The use of regional anesthesia in patients receiving anticoagulants is controversial. The purpose of this review is to document the incidence of neurologic complications with insertion and removal of an epidural catheter in patients receiving oral anticoagulants and antiplatelet medication.

Methods: A retrospective review was made of the charts of 459 patients who underwent hip pinning or hip or knee replacement under regional anesthesia and received postoperative epidural analgesia and warfarin thromboembolism prophylaxis. The number of patients receiving preoperative antiplatelet therapy and warfarin, as well as baseline coagulation parameters, was documented. For patients who had postoperative epidural analgesia, the prothrombin time on the day of epidural catheter removal was obtained. Neurologic complications during the hospital stay were noted.

Results: Spinal anesthesia was administered to 47 patients and epidural anesthesia and postoperative analgesia to 412. Before surgery, antiplatelet therapy was given to 270 and warfarin to 180 patients, with some patients receiving both. The mean +/- SD preoperative prothrombin and partial thromboplastin times were 10.8 +/- 1.2 seconds (normal, 9.6-11.1 seconds) and 27.5 +/- 3.5 seconds (normal, 24.6-33.2 seconds), respectively. Blood on needle or catheter insertion was noted in 21 patients, all of whom were taking antiplatelet medication and/or warfarin. Epidural catheters remained postoperatively for a mean of 43.6 +/- 12.5 hours (range 5-118 hours). The mean prothrombin time on the day of epidural catheter removal was 14.1 +/- 3.2 seconds. Four postoperative peripheral neuropathies were detected. There was no clinical evidence of spinal hematoma in any patient.

Conclusions: Epidural catheter placement and removal in patients taking oral anticoagulants appears to be safe. Careful monitoring of the patient for evidence of spinal hematoma after epidural catheter removal is recommended.

Background and objectives: It is often considered that essential thrombocythemia contraindicates placement of an epidural catheter because of the danger of epidural hematoma. Thromboelastography offers a possible means of determining the appropriateness of epidural analgesia in a patient with this disorder.

Methods: A pregnant woman with essential thrombocythemia and a history of spontaneous abortions was evaluated by thromboelastography at 38 weeks of gestation to determine the safety of using epidural analgesia for labor pain management. On the basis of the thermoelastography findings, the patient was given epidural analgesia with bupivacaine and fentanyl during her labor.

Results: The patient experienced good pain relief, delivered a healthy infant vaginally, and suffered no complications.

Conclusions: Thromboelastography may be a useful diagnostic test in determining the suitability of regional techniques for labor analgesia in parturients with essential thrombocythemia. However, success in one patient does not prove the general safety of this approach.

Background and objective: EMLA cream is an effective topical anesthetic, which is commonly used for analgesia during venous cannulation in the pediatric population. This study was designed to compare the efficacy of EMLA cream with that of infiltration with lidocaine in relieving the pain associated with administration of spinal anesthesia.

Methods: The patient population consisted of 41 ASA status I and II women scheduled for postpartum tubal ligation. Spinal anesthesia was administered with a 25-gauge spinal needle via a 20-gauge introducer. The patients were randomly allocated to receive either EMLA cream for a minimum of 30 minutes or infiltration with 3 mL of 1% lidocaine prior to spinal needle insertion. Pain during spinal needle insertion was assessed immediately after each procedure by a 10-cm visual analog scale.

Results: Pain scores were significantly lower in the EMLA group (mean, 1.5) than in the lidocaine group (mean, 3.52) (P < .001). The number of patients satisfied with the method of analgesia was significantly higher in the EMLA than in the lidocaine group (90% vs 55%, P < .05).

Conclusion: EMLA cream is an effective alternative to lidocaine infiltration for analgesia during the administration of spinal anesthesia when using a 25-gauge spinal needle via a 20-gauge introducer. Application of EMLA cream for at least 30 minutes prior to spinal needle insertion is adequate to provide good analgesia during needle insertion.