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Results for “Injections, Spinal”

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At least 217 records · Page 12Linked to original sources

PubMed1991

[Analysis of failures of spinal anesthesia as a function of practice development in a university hospital].

This study is a retrospective analysis of 303 consecutive spinal anaesthesia performed in orthopaedic patients of a University Hospital between January and December 1990. Failure of spinal anaesthesia was defined as the requirement for general anaesthesia to perform surgery. The parameters studied as possible risk factors of failure were patients demographics, local anaesthetic agents and solutions and techniques of spinal anaesthesia (single injection versus continuous spinal anaesthesia). Failures were related to inadequate or incomplete extension of sensory blockade or to difficulties to perform spinal injection. Continuous spinal anaesthesia was performed in 209 patients mostly with 0.5% isobaric bupivacaine, while 94 patients received a single injection of either hyperbaric 0.5% tetracaine with adrenaline or 0.5% bupivacaine or 5% lidocaine. Failures occurred in 6.3% of the cases but were significantly less frequent with continuous spinal anaesthesia (4.8%) than with the conventional technique (9.6%). The incidence of failure was higher with hyperbaric tetracaine (11.1%) confirming its poor reliability. Inadequate extension of the anaesthetic block was the main cause of failure whatever the spinal anaesthetic technique. These results point out the reliability of continuous spinal anaesthesia but problems may occasionally occur due to spinal catheter misplacement.

Academic Medical Centers↗

PubMed1993

Cytoarchitecture of spinal-projecting neurons in the brain of the larval sea lamprey.

The descending spinal projecting system of the lamprey is of interest because it includes axons that activate swimming pattern generators and because regeneration of this system is involved in the behavioral recovery of lampreys following spinal transection. However, little is known about the true size of this projection and of the distribution of its terminations along the spinal cord. Brain neurons with spinal projections were studied in larval sea lampreys by using wholemount preparations labeled retrogradely with horseradish peroxidase (HRP) from spinal injections at 10%, 15%, 25%, 50%, 70%, and 75% of body length from the anterior end. Neurons projecting to different levels of the spinal cord were mapped. A large number of descending axons terminated within nine segments caudal to the last gill. The spinal projection system was divided into 10 bilateral groups based on cytoarchitectural landmarks. All of the lateral nuclear groups had contralateral spinal projections. In addition to the 12 pairs of Müller cells, the pair of Mauthner cells, and the pair of auxiliary Mauthner cells described by previous authors, the study revealed four pairs of smaller neurons that were individually identifiable.

Animals↗

PubMed1996

Transient radicular pain following spinal anesthesia: review of the literature and report of a case involving 2% lidocaine.

Recent reports of transient radicular irritation following intrathecal administration of 5% lidocaine in 7.5% dextrose, a common drug choice in many obstetric centers, have generated concern that its use for single injection spinal anesthesia can result in transient neurologic toxicity. Accordingly, many have advocated dilution of this anesthetic solution prior to subarachnoid administration. The present report describes a case in which transient neurologic symptoms occurred following intrathecal injection of a solution containing approximately 2% lidocaine. The similarity of the present case to those previously reported implies a common etiology and suggests that risk is not restricted to the use of 5% lidocaine with 7.5% glucose. It underscores the need for carefully controlled prospective evaluation of the factors that affect transient neurologic dysfunction following spinal anesthesia.

Journal Article↗

PubMed2003

Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests.

Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference standards. The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference standard. In a blinded concurrent criterion-related validity design study, 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections. The centralisation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process. Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection. Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain. In the primary subset analysis of 34 patients, sensitivity, specificity and positive likelihood ratio (95% confidence intervals) of the clinical evaluation were 91% (62 to 98), 83% (68 to 96) and 6.97(2.70 to 20.27) respectively. The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone. A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac joints

Adult↗

PubMed1991

Influence of the lumbar interspace chosen for injection on the spread of hyperbaric 0.5% bupivacaine.

Forty patients undergoing elective Caesarean section were allocated randomly to receive hyperbaric 0.5% bupivacaine 2.5 ml at either the L2-3 (n = 20) or L4-5 (n = 20) interspace. Spinal injection was performed with a 29-gauge needle in 38 patients and a 25-gauge needle in two. The onset time to analgesia at T10 and T6 was significantly faster and the level of analgesia at 5 and 10 min after injection significantly higher after injection at L2-3. Maximum height and range of analgesia, the level of analgesia at 15 and 20 min after injection and the number of episodes of hypotension were not significantly different between the two groups. One case of post-dural puncture headache was recorded after use of a 29-gauge needle. Overall, the choice of lumbar interspace influenced the rate of onset of analgesia, but not the final dermatomal level (mean and range) of analgesia achieved.

Adolescent↗

PubMed1996

Neuronal damage following intraspinal injection of a nitric oxide synthase inhibitor in the rat.

Intraspinal microinjection of the nonspecific nitric oxide synthase (NOS) inhibitor N-nitro-L-arginine methyl ester (L-NAME) was used to determine if inhibition of NOS results in morphological changes in the rat spinal cord. Following spinal injections of 100-750 mM L-NAME (pH 7.0), 1.0-500 mM L-NAME (pH 2.5-5.4), or L-NAME + L-arginine, quantitative analysis of morphological changes revealed a positive dose-response relationship between L-NAME and neuronal loss. This effect was blocked by L-arginine and was inversely related to spinal levels of NOS enzyme activity. Results of this study have shown the importance of basal NOS activity in maintaining the structural integrity of spinal neurons. It is proposed that the effects of L-NAME on nitric oxide (NO) production leads to decreased blood flow, secondary to vasoconstriction, and a hypoxic-ischemic reaction in spinal tissue. The results suggest that a potential contributing factor to neuronal damage in pathological conditions such as spinal cord injury may be the decreased production of nitric oxide.

Animals↗

PubMed2000

Suppressed injury-induced rise in spinal prostaglandin E2 production and reduced early thermal hyperalgesia in iNOS-deficient mice.

It is widely accepted that peripheral injury increases spinal inducible cyclooxygenase (COX-2) expression and prostaglandin E(2) (PGE(2)) formation as key mediators of nociceptive sensitization. Here, we used inducible nitric oxide synthase (iNOS) gene-deficient (iNOS-/-) mice to determine the contribution of iNOS-derived nitric oxide (NO) to this process. iNOS-/- mice exhibited reduced thermal hyperalgesia after zymosan injection. Spinal NO and PGE(2) formation both remained at baseline levels, in contrast to wild-type (wt) mice. In wt mice reduced hyperalgesia similar to that seen in iNOS-/- mice was induced by local spinal, but not by systemic treatment with the iNOS inhibitor l-NIL, suggesting that the reduced heat sensitization in iNOS-/- mice was attributable to the lack of spinal rather than peripheral iNOS. Two additional observations indicate that the antinociceptive effects of iNOS inhibition are dependent on a loss of stimulation of PG synthesis. First, intrathecal injection of the COX inhibitor indomethacin, which exerted pronounced antinociceptive effects in wt mice, was completely ineffective in iNOS-/- mice. Second, treatment with the NO donor RE-2047 not only completely restored spinal PG production and thermal sensitization in iNOS-/- mice but also its sensitivity to indomethacin. In both types of mice induction of thermal hyperalgesia was accompanied by similar increases in COX-1 and COX-2 mRNA expression. The stimulation of PG production by NO therefore involves an increase in enzymatic activity, rather than an alteration of COX gene expression. These results indicate that NO derived from spinal iNOS acts as a fast inductor of spinal thermal hyperalgesia.

Animals↗

PubMed2005

Incidence of intravascular uptake during fluoroscopically guided lumbar disc injections: a prospective observational study.

BACKGROUND: Although there are many in vivo studies evaluating lumbar disc injections, no studies have described the occurrence of intravascular uptake of contrast on discography. This phenomenon, however, has been well documented for other fluoroscopically-guided, contrast-enhanced spinal injections. OBJECTIVES: To document the phenomenon and incidence of intravascular uptake during fluoroscopically-guided, contrast-enhanced lumbar disc injections. DESIGN: A prospective, observational, community-based study. METHODS: The incidence of fluoroscopically-confirmed intravascular uptake of contrast material was documented in 160 patients representing a subset of individuals presenting to a small private community hospital for evaluation and treatment of lower back pain. These patients underwent fluoroscopically-guided lumbar disc injections for therapeutic and/or diagnostic purposes. RESULTS: A total of 280 discs from L1-2 to L5-S1 were studied. The degree of disc degeneration of the evaluated discs was scored using the Adams' scoring criteria for intervertebral disc degeneration. The incidence of intravascular uptake as well as any correlation between stage of disc degeneration and intravascular uptake was statistically evaluated. A total of 40 out of 280 discs (14.3%) demonstrated intravascular uptake. Detection of intravascular uptake usually required real-time fluoroscopy. There was no statistical correlation between the degree of disc degeneration and the incidence of intravascular uptake. No disc infections or other adverse sequelae occurred. CONCLUSION: This is the first study, to our knowledge, that addresses the incidence of intravascular uptake during lumbar disc injections in patients with low back pain. The presence of intravascular uptake may have implications both clinically and diagnostically in regards to interpretation of lumbar discography and adverse events related to loss of injected medications into the vascular system.

Journal Article↗

PubMed1993

Spinal actions of NSAIDS in blocking spinally mediated hyperalgesia: the role of cyclooxygenase products.

Recent studies have shown that intrathecal NSAIDs can produce a significant, dose-dependent reduction in the second phase of the formalin response and block thermal hyperalgesia induced by spinally injected N-methyl-D-aspartate and substance P. These observations support the body of literature that indicate that sustained small fiber input yields a hyperalgesia through activation of spinal NMDA and NK1 receptors and that in turn a portion of this action is mediated by the spinal release of cyclooxygenase products.

Animals↗

PubMed1986

Collaterals of corticospinal and pyramidal fibres to the pontine grey demonstrated by a new application of the fluorescent fibre labelling technique.

Selective visualization of collaterals of corticospinal and pyramidal fibres to the pons in cat was obtained by retrograde transport of the fluorescent tracer fast blue (FB) through the stem fibres. Unilateral FB injections in the cervical cord and the pyramidal tract respectively produced soft blue fluorescent labelling of pyramidal fibres and of fibres and structures resembling 'terminals' in the pontine grey: contralateral to the spinal injections and ipsilateral to the pyramidal injections. These labelled elements were concluded to represent collaterals of corticospinal and pyramidal fibres because (a) their distribution corresponded to that of the pericruciate corticopontine fibres, (b) their labelling was prevented when the FB injections were preceded by a transection of either the cerebral peduncle or the pyramidal tract which lesions also prevented the FB labelling of the distal parts of the transected axons. Similar findings were obtained when using wheat germ agglutinin-horseradish peroxidase. In other experiments FB-labelling of pyramidal collaterals was combined with retrograde labelling of pontine neurones projecting to the contralateral anterior lobe of the cerebellum using diamidino yellow dihydrochloride as the second tracer. The distributions of the retrogradely labelled neurones and of the pyramidal collaterals in the pontine grey showed an almost complete overlap indicating that these collaterals mainly establish connections with the cerebellar anterior lobe.

Amidines↗

PubMed1988

Effects of neonatal spinal cord serotonin depletion on opiate-induced analgesia in tests of thermal and mechanical pain.

There is considerable evidence that serotonin (5-HT) is involved in the analgesic actions of various opiates. However, it is less clear which opioid receptor types interact with these descending systems and whether the various monoaminergic pathways are specific for different types of nociceptive signals. In the present study we lesioned the spinal cord serotonin pathways by neonatal spinal injections of 5,7-dihydroxytryptamine (5,7-DHT) and tested the analgesic effects of morphine and ketocyclazocine one and two weeks later using both mechanical and thermal noxious stimuli. The treatment depleted spinal cord serotonin by more than 90% while not affecting norepinephrine levels. The effects of morphine were greatly attenuated in the depleted animals when the thermal noxious stimulus was applied. The analgesic actions of morphine were only slightly affected when the mechanical stimulus was applied. The effects of ketocyclazocine were not reduced by the treatment. The results further buttress the conclusion that at least part of morphine's analgesic effects are mediated by descending serotonin systems and that these systems are primarily effective against a thermal stimulus. The data suggest that non-5-HT brainstem system(s) are involved in morphine-induced analgesia to a mechanical noxious stimulus.

5,7-Dihydroxytryptamine↗

PubMed2005

Transient neurological symptoms with subarachnoid lidocaine: effect of early mobilization.

BACKGROUND AND OBJECTIVE: Although lidocaine has been used extensively for spinal anaesthesia since 1949, it has been associated with transient neurological symptoms only in the past 10 yr. It has been suggested that early ambulation after spinal anaesthesia, as opposed to traditional 24 h recumbency, might be the causative factor for the development of transient neurological symptoms. The purpose of this study was to examine the effect of early ambulation on the incidence of transient neurological symptoms after single injection spinal anaesthesia with lidocaine 2%. METHODS: Sixty patients undergoing minor surgery under spinal anaesthesia were included. All patients received lidocaine 60 mg. After the establishment of successful subarachnoid block, patients were randomly allocated to two groups of 30 patients. Patients in Group 1 were ambulated as soon as possible, whereas patients in Group 2 were kept recumbent until 6 h after subarachnoid injection. Two days after surgery patients were contacted by a blinded observer and interviewed of transient neurological symptoms using a standardized questionnaire. Patients were asked to express the intensity of pain/discomfort on a verbal rating scale from 0 (no pain) to 10 (worst pain imaginable). RESULTS: There was no significant difference in the incidence of transient neurological symptoms (23% vs. 27%). In all patients, symptoms resolved completely within 6-24 h. The median pain score was 5 (range 2-8) in Group 1 and 7 (range 1-8) in Group 2. CONCLUSIONS: Under the conditions of this study, there is no correlation between the time of ambulation after spinal anaesthesia with lidocaine and the incidence of transient neurological symptoms.

Adult↗

PubMed2000

Extraterritorial neuropathic pain correlates with multisegmental elevation of spinal dynorphin in nerve-injured rats.

Neuropathic pain is often associated with the appearance of pain in regions not related to the injured nerve. One mechanism that may underlie neuropathic pain is abnormal, spontaneous afferent drive which may contribute to NMDA-mediated central sensitization by the actions of glutamate and by the non-opioid actions of spinal dynorphin. In the present study, injuries to lumbar or sacral spinal nerves elicited elevation in spinal dynorphin content which correlated temporally and spatially with signs of neuropathic pain. The increase in spinal dynorphin content was coincident with the onset of tactile allodynia and thermal hyperalgesia. Injury to the lumbar (L(5)/L(6)) spinal nerves produced elevated spinal dynorphin content in the ipsilateral dorsal spinal quadrant at the L(5) and L(6) spinal segments and in the segments immediately adjacent. Lumbar nerve injury elicited ipsilateral tactile allodynia and thermal hyperalgesia of the hindpaw. In contrast, S(2) spinal nerve ligation elicited elevated dynorphin content in sacral spinal segments and bilaterally in the caudal lumbar spinal cord. The behavioral consequences of S(2) spinal nerve ligation were also bilateral, with tactile allodynia and thermal hyperalgesia seen in both hindpaws. Application of lidocaine to the site of S(2) ligation blocked thermal hyperalgesia and tactile allodynia of the hindpaws suggesting that afferent drive was critical to maintenance of the pain state. Spinal injection of antiserum to dynorphin A((1-17)) and of MK-801 both blocked thermal hyperalgesia, but not tactile allodynia, of the hindpaw after S(2) ligation. These data suggest that the elevated spinal dynorphin content consequent to peripheral nerve injury may drive sensitization of the spinal cord, in part through dynorphin acting directly or indirectly on the NMDA receptor complex. Furthermore, extrasegmental increases in spinal dynorphin content may partly underlie the development of extraterritorial neuropathic pain.

Anesthetics, Local↗

PubMed2005

[Spinal anaesthesia for Caesarean section: dose injection speed have an effect on the incidence of hypotension?].

OBJECTIVE: To study effect of injection rate on spinal blockade and haemodynamic of spinal bupivacaine for Caesarean section. STUDY DESIGN: Prospective and randomized. PATIENTS AND METHODS: Sixty ASA I-II patients scheduled for elective Caesarean section were randomized to receive either fast (20 seconds, group R, n=30) or slow (60 seconds, group L, n=30) spinal injection of 10 mg of hyperbaric bupivacaine 0.5% associated with 25 microg of fentanyl and 100 microg of morphine. Sensory and motor blockade and haemodynamic parameters were recorded. RESULTS: Profiles of sensory and motor block were similar in both groups. Variations of arterial blood pressure and total dose of ephedrine were not different between R and L groups. However, the number of patient with systolic blood pressure lower than 100 mmHg were significantly lower in L group than in R group (p=0.04). Incidences of adverse effects were similar in both groups. CONCLUSION: Result of the present study suggests that a slow rate of injection would induce lower incidence of hypotension induced by spinal bupivacaine for Caesarean section.

Adjuvants, Anesthesia↗

PubMedDate not supplied

Spinal anesthesia for postpartum tubal ligation after pregnancy complicated by preeclampsia or gestational hypertension.

BACKGROUND AND OBJECTIVES: The American College of Obstetricians & Gynecologists has opposed postpartum tubal ligation (PPTL) in patients whose pregnancies have been complicated by a medical condition, including hypertension. A prospective study was conducted to assess the appropriateness of spinal anesthesia for PPTL in patients with hypertensive disorders of pregnancy. METHODS: After institutional review board approval and written informed consent, women scheduled for PPTL were enrolled. The hypertensive group (n = 25) consisted of women whose pregnancies were complicated by gestational hypertension, preeclampsia, or chronic hypertension with superimposed preeclampsia. For each hypertensive patient, a matched control was designated by selecting the next consenting normotensive patient scheduled for PPTL. After an intravenous bolus of lactated ringers solution 500 mL, spinal anesthesia was induced with hyperbaric lidocaine. Hemodynamic measurements were recorded every 2 minutes for 20 minutes after spinal injection. Ephedrine IV was administered for systolic blood pressure < or =90 mm Hg. RESULTS: The mean preoperative mean blood pressure (MAP) was 107+/-17 mm Hg in the hypertensive group and 85+/-11 mm Hg in the controls, P<.0001. The hypertensive group sustained a more profound percentage decrease in MAP than did their control counterparts during spinal anesthesia (29%+/-12% v. 15%+/-8%, P<.0001). However, the lowest intraoperative MAP was similar in both groups. Thirty-five percent of hypertensive patients and 24% of the controls received ephedrine IV. CONCLUSIONS: PPTL during spinal anesthesia in patients whose pregnancies have been complicated by hypertension had results comparable with patients with uncomplicated pregnancies; however, further studies are needed to ascertain its safety.

Adult↗

PubMed2000

Two additional cases of excessive extension of sensory blockade after intrathecal sufentanil for labor analgesia.

Combined spinal-epidural anesthesia (CSE) is an effective technique with rapid onset of labor analgesia. We describe two cases of excessive cephalad spread of sensory blockade without motor blockade in two parturients in spontaneous labor with CSE. The patients received sufentanil 5 microg intrathecally with 1.25 mg bupivacaine. Spinal injection produced dyspnea and extension of sensory blockade to cervical or facial level without fetal consequences. We conclude that the risk of these side-effects previously described with the 10 microg dose persists for lower sufentanil spinal doses.

Journal Article↗

PubMed1978

Directional spinals in obstetric analgesia.

Directional characteristics of spinal injections delivered via a 22 gauge Whitacre needle were confirmed in twenty-one obstetric patients undergoing elective Caesarean section. Caudad injection was inadequate for elective Caesarean section, while cephalad or lateral injection provided good sensory levels for the duration of the surgery. It is speculated that along with the low incidence of postspinal headache and ease of administering the block with a more rigid 22 gauge needle, low dose caudally directed injections may provide a superior means of administering saddle block analgesia for obstetric patients.

Anesthesia, Obstetrical↗

PubMed1998

Postural post-dural puncture headache after spinal and epidural anaesthesia. A randomised, double-blind study.

BACKGROUND: This study was conducted in order to investigate the effect of patient expectation in the development of postural post-dural puncture headache (PPDPH). METHODS: 224 patients less than 55 years scheduled for minor non-obstetric surgery were randomised to receive single-injection spinal (SA) or epidural (EA) anaesthesia. A 27-g Quinke needle was used for SA and a 18-g Tuohy needle for EA. Patients, operating team and postoperative ward personnel were all blinded to the anaesthetic given and so was an independent observer responsible for follow-up after 5-7 days. The occurrence of headache, backache and other complaints was recorded. Headache was classified as PPDPH or non-PPDPH, and duration and intensity of the headache was registered. The quality of anaesthesia was directly evaluated by the surgeon using a VAS scale from 1 (excellent) to 10 (very poor) and indirectly by the supplemental use of opioid analgesia and general anaesthesia in the two groups. RESULTS: 212 patients, 103 SA and 109 EA, with a mean age of 36.7 years, could be fully evaluated. The groups were comparable with regards to age, sex and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 16 patients (15.5%) in the SA group and 2 (1.8%) in the EA group (P = 0.0014). Non-PPDPH occurred in 13 patients in each group. PPDPH had significantly greater mean intensity and duration than non-PPHPH. More patients in the EA group had postoperative backache (31.2%) than in the SA group (22.3%), but this difference was not statistically significant. More patients in the EA received general anaesthesia and opioid analgesia than in the SA group, and the surgeon's rating was on average 1.3 in the SA group compared to 2.5 in the EA group (P = 0.0003). CONCLUSIONS: SA gave more headache but superior quality of surgical anaesthesia compared with EA. Dural puncture, and not expectation, is the major cause of PPDPH.

Adult↗