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M Curatolo

Publications and source records attributed to M Curatolo.

At least 37 records · Page 2Linked to original sources
PubMed1996

Factors associated with hypotension and bradycardia after epidural blockade.

In order to identify patient-, anesthesia-, and surgery-related factors influencing the probability of hypotension and bradycardia after epidural blockade, an observational study was conducted on 1050 nonpregnant patients. Backward stepwise logistic regression was performed on the variables hypotension (systolic blood pressure < 90 mm Hg) and bradycardia (heart rate < or = 45 bpm). Hypotension and bradycardia occurred in 158 and 24 patients, respectively. The probability of hypotension increased when epidural fentanyl was administered (odds ratio [OR] = 2.18; 95% confidence interval [CI] = 1.16-4.11), with body weight and spread of epidural analgesia, and decreased when a tourniquet was used (OR = 0.01, CI = 0.01-0.02) and bupivacaine instead of carbonated lidocaine was administered (OR = 0.28, CI = 0.14-0.60). Sensitivity and specificity of the model were 89% and 88%, respectively. The probability of bradycardia was less in women (OR = 0.05, CI = 0.01-0.41) and when a tourniquet was used (OR = 0.04, CI = 0.02-0.09). Sensitivity and specificity were 50% and 97%, respectively. In conclusion, our analysis can contribute to identification of patients at high risk to develop hypotension and bradycardia after epidural blockade. If bupivacaine instead of carbonated lidocaine is used and epidural fentanyl is not administered a decrease in the incidence of hypotension may be anticipated.

Adjuvants, Anesthesia↗
PubMed1995

A multifactorial analysis to explain inadequate surgical analgesia after extradural block.

A multivariate analysis of inadequate extradural analgesia was carried out prospectively on 1051 patients undergoing lumbar extradural anaesthesia for surgery performed on structures innervated by T10-S5. Ninety-six patients (9%) experienced pain during surgery. Age, extradural fentanyl, diazepam sedation and duration of surgery had no significant influence. We found some weak evidence that the type of surgery affects the risk of feeling pain. The probability of pain increased with increasing weight, except in overweight women, and was significantly greater for both shorter and taller patients, relative to patients of average height. The probability of pain decreased with increasing dose of local anaesthetic, increasing spread of extradural analgesia, addition of adrenaline, and fentanyl or thiopentone sedation. In conclusion, patient-, surgery- and anaesthesia-related factors influence the risk of inadequate extradural analgesia. If such factors are taken into account, an increase in the success rate may be anticipated.

Adolescent↗
PubMed1995

Temporal summation during extradural anaesthesia.

We have investigated in 10 patients the effect of extradural anaesthesia on temporal summation by comparing pain thresholds to single and repeated (five impulses at 2 Hz) electrical stimuli and compared these tests with pinprick and cold stimulation. Bupivacaine 0.5% (20 ml) was injected at L2-3. After extradural anaesthesia the threshold to repeated stimuli was significantly lower than the threshold to single stimuli (P = 0.0007). Nine patients lost cold sensation and 10 patients pinprick sensation. Pain to single electrical stimulation disappeared in six patients and pain to repeated electrical stimulation in one. Pain may be evoked by temporal summation of repeated electrical stimuli even when pinprick sensation, cold sensation and pain to single electrical stimuli are inhibited. Thus temporal summation should be taken into consideration when extradural analgesia is assessed.

Adult↗
PubMed1995

Failure rate of epidural anaesthesia for foot and ankle surgery. A comparison with other surgical procedures.

To test whether epidural anaesthesia for foot and ankle surgery is associated with an unacceptably high incidence of inadequate surgical analgesia, we prospectively compared two groups of patients, one undergoing foot or ankle surgery (160 patients) and the other surgical procedures not performed in areas innervated by L5-S1 ( (168 patients). Lumbar epidural anaesthesia was performed in both groups by administering carbonated lignocaine 2% with adrenaline 1:200000. Seven patients in the foot-ankle group (4.4%) and 10 in the group for comparison (5.9%) exhibited inadequate surgical analgesia. This difference is not statistically significant. Within the foot-ankle group, a significantly lower dose of local anaesthetic per spinal segment had been given to patients who displayed inadequate analgesia, compared with those who exhibited satisfactory analgesia (P < 0.05).

Adjuvants, Anesthesia↗
PubMed1994

A multifactorial analysis of the spread of epidural analgesia.

The controversies about the factors determining the spread of epidural analgesia are partly due to inappropriate methodology or sample size of previous studies. We performed a multivariate regression analysis on 803 ASA class 1-2 non-atherosclerotic adults, undergoing lumbar epidural anaesthesia according to a predefined standardised procedure. The spread of epidural analgesia is more accurately studied by analysing dose/segment (R2 = 0.671) instead of spread (R2 = 0.271) as dependent variable. The impact of local anaesthetic (2% lidocaine CO2 or 0.5% bupivacaine) and addition of adrenaline is not significant. Spread significantly increases with increasing age, weight, body-mass index, dose of local anaesthetic, addition of fentanyl, higher site of injection, and decreasing body height. The impact of age and dose is higher under the age of 40 and at doses lower than 20 ml. Increasing the total dose increases the dose needed to block one spinal segment. Unknown idiosyncratic factors still determine a certain proportion of the sample variance. The addition of adrenaline to lidocaine and the use of bupivacaine improve the predictability of spread. In conclusion, we found clinically significant correlations between a group of factors and epidural spread. Alternative anaesthetic solutions lead to different degrees of predictability.

Adolescent↗
PubMed1994

[Comparison of carbonated lidocaine and mepivacaine in epidural anesthesia].

OBJECTIVE: To compare carbonated mepivacaine to carbonated lidocaine in epidural anaesthesia. DESIGN: Nonrandomised control trial. SETTING: University Hospital. PATIENTS: Forty patients undergoing epidural anaesthesia for orthopaedic surgery. METHODS: Epidural anaesthesia at the fourth lumbar interspace, administering either carbonated mepivacaine 20 ml (group M, 20 patients) or carbonated lidocaine 20 ml (group L, 20 patients). Parameters recorded: onset of sensory block (time required to reach L1 and time required to reach the upper level), cranial spread of analgesia (number of dermatomes), duration of block (time between achievement of maximum spread of analgesia and regression of sensory block by two dermatomes) and motor block (Bromage score). RESULTS: No statistically significant differences have been found between group M and group L in the time required to reach L1 (means and standard deviations 6.3 +/- 3.8 and 6.5 +/- 2.1 minutes, respectively), in the time required to reach the upper level of analgesia (means and standard deviations 14.3 +/- 4.2 and 16.5 +/- 3.5 minutes, respectively), in the cranial spread of analgesia (means and standard deviations 7.1 +/- 3.4 and 7.6 +/- 2.7 dermatomes, respectively) and in the degree of motor block (means and standard deviations 1.5 +/- 0.8 and 1.1 +/- 0.8, respectively). Group M exhibited a much higher duration of sensory block, compared to group L (means and standard deviations 91.6 +/- 20.2 and 58.8 +/- 23.4 minutes, respectively, p < 0.001). CONCLUSIONS: Carbonated mepivacaine is more indicated than carbonated lidocaine in epidural anaesthesia when a high duration of sensory block is desired.

Adult↗
PubMed1992

[Postoperative pain in shoulder surgery].

Postoperative shoulder pain should be adequately treated not only because of the high severity of the symptomatology often observed, but also because pain and muscle contraction render impossible an early rehabilitation programme. Regional anaesthesia, by virtue of its beneficial effects on the pathophysiology of pain and its influence on the rehabilitative problems of shoulder surgery, is the most adequate technique for the control of postoperative pain.

Analgesia↗