SEARCH · PubMed Health

Results for “Injections, Spinal”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources

PubMed2002

Role of adenosine receptors in spinal G-protein activation after peripheral nerve injury.

BACKGROUND: Spinally injected adenosine induces antinociception in animal models of neuropathic but not acute pain. The reasons for this discrepancy remain unclear. Adenosine receptors are coupled to G proteins, and increased efficiency of adenosine-induced G-protein activity in neuropathic pain could contribute to the antinociceptive effect of adenosine. In this study the authors used [(35)S]guanosine-5'-O-(3-thiotriphosphate) ([(35)S]GTP gamma S) autoradiography in rat spinal cord sections to test this possibility. METHODS: The spinal cords of normal animals and those that underwent left L5 and L6 spinal nerve ligation (SNL) were removed and immediately frozen. Horizontal spinal cord sections were cut and mounted on chrom-alum gelatin-subbed slides. Sections were incubated with guanosine diphosphate, [(35)S]GTP gamma S, the adenosine A1 agonist R-N6-phenylisopropyladenosine, and various other drugs, apposed to films, and analyzed. RESULTS: Baseline and R-N6-phenylisopropyladenosine-stimulated [(35)S]GTP gamma S binding was predominantly localized to the superficial dorsal horns of both normal and SNL animals. This binding was significantly increased in SNL compared with normal animals. In contrast, no difference in R-N6-phenylisopropyladenosine-stimulated [(35)S]GTP gamma S binding was observed between SNL and normal animals. Blockade of adenosine A1 receptors by 1,3-dipropyl-8-cyclopentylxanthine, or adenosine destruction by added adenosine deaminase, reduced the increased basal activity in SNL to baseline levels of normal dorsal horns, whereas atropine and naloxone had no effect. CONCLUSION: This study shows an increased basal G-protein activity in lumbar spinal cords during conditions of SNL. The data suggest that increased adenosine release during conditions of SNL results in an increased basal activity of G proteins in the spinal cord during neuropathic pain.

Adenosine↗

PubMed2003

Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine.

BACKGROUND: Micturition problems after spinal anaesthesia may delay hospital discharge. The use of lidocaine has raised concerns because of the occurrence of transient neurological symptoms (TNS). This randomized double-blind study was designed to compare the newer local anaesthetics with lidocaine regarding block characteristics, micturition problems, and discharge times in day-case spinals for arthroscopy. METHODS: Ninety patients received either isobaric lidocaine 60 mg, ropivacaine 15 mg, or levobupivacaine 10 mg intrathecally. Urinary bladder volumes were measured by ultrasound imaging at regular time intervals until a post-voiding residual volume (PVRV) less than 100 ml was obtained. Micturition problems were classified in five groups ranging from no problems to those requiring catheterization. RESULTS: Times to regain a Bromage-1 and -0 motor block were similar in the three groups but sensory block regression to L2 occurred at 145 (30) min in the lidocaine group, 25-30 min (P<0.05) faster than the other groups. Lidocaine allowed voiding after 245 (65) min and hospital discharge 265 (70) min after spinal injection, 40 min faster than in the two other groups. The incidence or degree of micturition problems were not different between after discharge, three patients (10%) receiving lidocaine complained of symptoms compatible with TNS. CONCLUSIONS: Our study suggested that the three local anaesthetics behave similar regarding quality of anaesthesia and motor block but voiding and discharge occurred significantly earlier with lidocaine although the 40 min difference was not impressive considering a spinal discharge time interval of 4-5 h.

Adolescent↗

PubMed2006

Spinal anaesthesia for cesarean section with reduced dose of intrathecal bupivacaine plus fentanyl.

BACKGROUND AND OBJECTIVES: The hypotension following spinal anesthesia remains common place in cesarean delivery. The combination of reduced dose of local anesthetics with intrathecal opioids makes it possible to achieve adequate spinal anesthesia with minimum hypotension. We investigate whether this synergistic phenomenon could be used to provide less frequent hypotension while incurring adequate spinal anesthesia for cesarean section. METHODS: Forty women scheduled for cesarean delivery (twenty in each group) were divided into two groups of patients who received a spinal injection of either 13.5 mg of standardized isobaric 0.5% bupivacaine or 9 mg of isobaric bupivacaine with 20 microgr fentanyl added. Each measurement of a systolic blood pressure less than 95 mm Hg or a decrease in systolic pressure of greater than 25% from baseline was considered as hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of surgical anesthesia was evaluated also. RESULTS: Spinal block provided excellent surgical anesthesia in almost all patients. Peak sensory level was higher (Th 2-3 vs. Th 4-5) and motor block was more intense in the plain bupivacaine group; the patients from standardized bupivacaine group were more likely to require treatment for hypotension (75% vs 15%) and had more persistent hypotension (4.6 vs. 1.0 hypotensive measurements per patient) than patients in the reduced bupivacaine-fentanyl group. Mean ephedrine requirements were 22.0 mg and 3.5 mg, respectively. Patients in the bupivacaine group also complained of emetic effects more frequently than patients in the reduced dose bupivacaine-fentanyl group. CONCLUSIONS: Bupivacaine 9 mg plus fentanyl 20 microgr provided spinal anesthesia for cesarean delivery with less hypotension and vasopressor requirements while ensuring excellent perioperative surgical anesthesia.

Adjuvants, Anesthesia↗

PubMed1996

Coronary perfusion pressure during cardiopulmonary resuscitation after spinal anesthesia in dogs.

Cardiac arrest during spinal anesthesia is a rare event, but when it does happen cardiopulmonary resuscitation (CPR) is often ineffectual. This study examines the effect of spinal anesthesia on coronary perfusion pressure (CPP) during CPR and the subsequent response of CPP to epinephrine administration. Twenty mongrel dogs were anesthetized, and randomly assigned to a spinal injection with either 0.5 mg/kg bupivacaine or with an equivalent volume of normal saline. Twenty minutes later, ventricular fibrillation was electrically induced and after 1 min CPR was started. CPP was measured every minute. After 4 min of CPR, epinephrine 0.01 mg/kg was given followed by 0.1, 0.2, and 0.4 mg/kg epinephrine intravenously (IV) at 6, 8, 10 min of CPR, respectively. The bupivacaine (n = 11) group had significantly less CPP than the sham spinal (n = 8) group, 12-13 mm Hg as compared to 27-34 mm Hg. Only 4/11 dogs (36%) in the bupivacaine group had CPP > or = 15 mm Hg during the first 4 min after arrest as compared to 8/8 (100%) in the sham spinal group. This increased to 7/11 dogs (64%) after 0.01 mg/kg epinephrine and to 9/11 after 0.1 mg/kg epinephrine. Total spinal anesthesia decreases CPP and thus the efficacy of CPR in dogs below the threshold previously established for predicting successful resuscitation. Epinephrine is effective in increasing CPP during CPR above the critical threshold. These data suggest that if cardiac arrest occurs during spinal anesthesia, epinephrine should be given in doses of 0.01-0.02 mg/kg IV initially and then increasing to 0.1 mg/kg IV. When this does not work, and ineffective CPR is suspected, alternative resuscitative measures should be considered.

Anesthesia, Spinal↗

PubMed1989

[A case of apnea during spinal anesthesia after intravenous injection of sedatives].

During spinal anesthesia for appendectomy (sensory level: -Th7), apnea occurred for about 20 minutes by intravenous administration of diazepam. Since the patient showed hyperventilation sign before the incident, this apnea might be caused by low PaCO2 and stopping respiratory stimulation from psychological unrest when diazepam, pentazocine and droperidol were administered. In the postoperative period, this patient showed normal neurologic and psychosomatic functions. In such a case as this, long duration of apnea might damage brain by severe hypoxia. Apnea after hyperventilation during spinal anesthesia as observed in this case could lead to a serious accident.

Adult↗

PubMed2005

A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement.

Total hip replacement is a major surgical procedure usually associated with significant pain in the early postoperative period. Several anaesthetic and analgesic techniques are in common clinical use for this procedure but, to date, clinical studies of pain after total hip replacement have not been systematically assessed. Using the Cochrane protocol, we have conducted a systematic review of analgesic, anaesthetic and surgical interventions affecting postoperative pain after total hip replacement. In addition to the review, transferable evidence from other relevant procedures and clinical practice observations collated by the Delphi method were used to develop evidence-based recommendations for the treatment of postoperative pain. For primary total hip replacement, PROSPECT recommends either general anaesthesia combined with a peripheral nerve block that is continued after surgery or an intrathecal (spinal) injection of local anaesthetic and opioid. The primary analgesic technique should be combined with a step-down approach using paracetamol plus conventional non-steroidal anti-inflammatory drugs, with strong or weak opioids as required.

Analgesia↗

PubMed2000

[Centenary of spinal anesthesia in Spain: first steps (1899-1904)].

With the aim of commemorating the centennial of the first spinal anesthesia in Spain, we review the process followed during the early phase of application of the technique, the period associated with spinal injection of cocaine, which was the only anesthetic agent used. We describe the first trials, the influence of the Paris Congress of 1900 in spreading interest in the technique, the varied degree of acceptance by Spanish authors, and the gradual uneasiness with the procedure that arose as a result of accidents. A look at reports by Pi Sunyer and Raventós concerning possible toxic effects on the central nervous system close this overview of the earliest times of spinal anesthesia in Spain.

Anesthesia, Spinal↗

PubMedDate not supplied

Effects of speed of intrathecal injection on unilateral spinal block by 1% hyperbaric bupivacaine. A randomized, double-blind study.

BACKGROUND: To evaluate if the speed of intrathecal injection affects the lateral distribution of spinal block during unilateral spinal anaesthesia with 1% hyperbaric bupivacaine. METHODS DESIGN: prospective, randomized, double-blind study. SETTING: anaesthesia Department at a University Hospital. PATIENTS: 30 ASA physical status I-II patients, scheduled for elective orthopedic surgery involving one lower limb only (ankle and foot surgery). INTERVENTIONS: after placing the patients in the lateral decubitus position with the site to be operated on dependent, dural puncture was performed at L3-L4 interspace using a 25-Gauge Whitacre spinal needle. After the needle hole had been turned toward the dependent side, patients were randomized to receive 8 mg of 1% hyperbaric bupivacaine injected over either 40 sec (Group SLOW, n = 15) or 3 sec (Group FAST, n = 15). The lateral position was maintained for 15 min. MEASUREMENTS: a blind observer evaluated the evolution of sensory (pinprick test) and motor (modified Bromage scale) blocks on both the dependent and nondependent sides until the regression of motor block by one degree. RESULTS: No differences in the maximal sensory level on both the dependent and nondependent sides were observed in the two groups. Unilateral sensory block was onserved in 6 patients in group SLOW (40%) and in 5 patients in group FAST (33%), (p = not significant[NS]. Unilateral motor block was observed in 9 patients in group SLOW (60%) and in 10 patients in group FAST (66%) (NS). CONCLUSIONS: Extremely reduced speeds of intrathecal injection did not improve the lateral distribution of spinal block when injecting 8 mg of 1% hyperbaric bupivacaine through a pencil-point directional spinal needle.

Adult↗

PubMedDate not supplied

The effect of head-down tilt position on arterial blood pressure after spinal anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: The effect of the head-down tilt position after induction of spinal anesthesia for cesarean delivery on blood pressure and level of sensory block was examined. METHODS: Patients were allocated randomly into two groups, the head-down tilt group (n = 17) and the horizontal group (n = 17). In the head-down tilt group, patients were positioned with a 10 degrees head-down tilt immediately after supine positioning, while those in the horizontal group were maintained in a horizontal position. All patients received 500 mL of lactated Ringer's solution intravenously over 10 minutes prior to spinal injection, a wedge was placed under the patient's right hip, and the operating table was rotated 5 degrees in a counterclockwise direction to provide left uterine displacement. Hypotension (defined as systolic blood pressure below 100 mm Hg) was treated with 5 mg ephedrine intravenously and an increase in the infusion rate of lactated Ringer's solution. The change in systolic blood pressure was expressed as percent change from the baseline value. RESULTS: Systolic blood pressure decreased 20% at 3 minutes after spinal block in both groups but recovered to half of this decrease. The incidence of postspinal hypotension was not different between the two groups. The total amount of ephedrine and lactated Ringer's solution administered during the first 20 minutes of spinal block did not differ between the two groups nor did the extent of the cephalad spread of analgesia 20 minutes after spinal block (T4 +/- 2 vs T4 +/- 1 for the head-down and horizontal groups, respectively). CONCLUSIONS: The head-down position is concluded to have no effect on the incidence of hypotension during spinal anesthesia for cesarean delivery.

Adult↗

PubMed2000

[Opioid spinal anesthesia at the end of labor for potentially difficult deliveries].

We report two cases of difficult delivery, one vaginal breech presentation and one vaginal twin delivery in agitated parturients who were not given epidura analgesia. Maternal agitation was caused by pain and led to the risk of difficult fetal extraction. Epidural analgesia is not useful during the second stage of labor because of delayed onset of action of the administered drugs. Spinal injection of 10 microg of sufentanil was followed by rapid analgesia, maternal sedation and atraumatic deliveries. The usefulness of this technique is discussed for analgesia during the second stage of labor when epidural analgesia has not been performed.

Adult↗

PubMed1999

Motor neuron degeneration due to aluminium deposition in the spinal cord: a light microscopical study.

For a long time, aluminium has been considered as an indifferent element from a toxicological point of view. In recent years, it became clear that aluminium is a potential toxic agent in humans and has been implicated in the pathogenesis of several clinical disorders, such as dementia, respiratory tract disorders and allergic reactions. Chronic exposure to aluminium fumes, inhalation of aluminium and aluminium-oxide powder increase the risk to develop serious central nervous system pathology, in particular Alzheimer's disease and amyotrophic lateral sclerosis (ALS). In the present study, 3 experimental and 1 control group of rats were used to study the effects of aluminium on the central nervous system. Aluminium was injected intracisternally as a single dose (50 micrograms for group I, 100 micrograms for group II and 300 micrograms for group III) to the experimental groups (n = 5 in each group). The same dose was given at 3 months after the first injection to all groups. The control group (n = 5) was intracisternally given a physiological salt solution. Electromyography (EMG) was applied to the rats of the experimental groups. Rats were decapitated at 3 months after the second injections. Spinal cord samples from lumbar and cervical regions were removed and histological examination was performed. Light microscopical investigations revealed severe degeneration in motor neurons of the rats treated with 300 micrograms. Neurofibrillary tangle formation, chromatolysis and abnormal localization of the nuclei were found in swollen perikarya. Extreme loss of motor neurons with "ghost cell" appearance was found in that group. Sections of spinal cords of rats treated with lower doses of aluminium showed a moderate degree of motor neuron damage. EMGs of rats treated with the high dose of aluminium revealed severe acute denervation whereas treatment with lower doses resulted in moderate denervation. We conclude that aluminium may cause severe motor neuron damage in rat spinal cord resembling ALS.

Aluminum↗

PubMed1983

[Blood and cerebrospinal fluid levels of bupivacaine in spinal anesthesia].

Blood and liquor concentrations of bupivacaine were followed in 20 patients after spinal injection of 15 mg bupivacaine-HCl or bupivacaine-CO2; determination of the local anaesthetic was done by gas chromatography. Whole-blood concentrations of bupivacaine for both formulations lay between 0.2 and 0.3 microgram/ml. Two min after intrathecal administration of 15 mg bupivacaine, liquor concentrations averaged around 600 micrograms/ml, i.e., the precipitation threshold was not reached. Concentrations of individual patients, however, indicated that considerably higher concentrations can be attained; the possible reasons are discussed. Bupivacaine-CO2 represents a suitable preparation for spinal anesthesia, which, particularly with regard to blood levels, shows no disadvantages compared to bupivacaine-HCl.

Adult↗

PubMed1996

Spinal anaesthesia in newborns: total and free bupivacaine plasma concentration.

This study was designed to measure total and free bupivacaine (B) after spinal anaesthesia in newborns and to evaluate a possible influence of adrenaline on B absorption. Twenty-two newborns were randomly allocated to receive either plain B (group 1) or adrenaline added to B (group 2) for spinal anaesthesia. A single blood sample was collected ten min after spinal injection. Total B concentration was found 0.31 +/- 0.17 microgram ml-1 in group 1 and 0.25 +/- 0.09 microgram ml-1 in group 2. Bound B concentration was 0.27 +/- 0.17 microgram ml-1 in group 1 and 0.22 +/- 0.09 microgram ml-1 in group 2. No difference was found between the two groups for these parameters. Albumin but not alpha 1-acid-glyco-protein correlated to age and weight, bound B correlated to alpha 1-acid-glyco-protein but not to albumin. Despite the low plasma concentration of binding proteins in newborns, spinal anaesthesia with B does not result in a high level of free drug. Adrenaline does not have any pharmacological advantage in these patients.

Absorption↗

PubMed2005

Improved analgesia with clonidine when added to local anesthetic during combined spinal-epidural anesthesia for hip arthroplasty: a double-blind, randomized and placebo-controlled study.

BACKGROUND: The perioperative effects of intrathecal and epidural clonidine combined with local anesthetic were evaluated in 60 patients undergoing hip arthroplasty. METHODS: This was a double-blinded study and the patients were randomized into three groups, with 20 patients in each group. All patients received spinal anesthesia with 17.5 mg of plain bupivacaine with 15 microg of clonidine (Group BC-RC) or without clonidine (Groups B-R and B-RC). Postoperatively, epidural infusion was administered in the following way: Group B-R-ropivacaine 4 mg h(-1); Groups B-RC and BC-RC: ropivacaine 4 mg h(-1) and clonidine 40 microg h(-1). Sensory block was assessed with light touch, pinprick, transcutaneous electrical stimulation at T12 and L2 dermatomes, and perception of thermal stimuli. RESULTS: The maximal upper level of sensory block measured by pin-prick (T6-T7) did not differ between the groups while the partial sensory block for cold and warmth were increased two dermatomes above pin-prick level in the group with intrathecal clonidine compared to the other two groups (P < 0.05). Duration of anesthesia, analgesia and motor block were longer in Group BC-RC compared to Groups B-R and B-RC (P < 0.02). Postoperatively, both VAS score on movement and PCA-morphine consumption were higher in Group B-R than in Groups B-RC and BC-RC (P < 0.01). The arterial pressure and heart rate in Groups B-RC and BC-RC were significantly lower than in Group B-R at 10-24 and 15-24 h, respectively, after spinal injection. CONCLUSION: Low-dose intrathecal clonidine provided a better quality of anesthesia and longer-lasting analgesia. Epidural clonidine-ropivacaine infusion resulted in improved postoperative analgesia but was associated with a moderate decrease in blood pressure.

Adjuvants, Anesthesia↗

PubMed1986

Peripheral versus central components of the effects of dermorphin on intestinal motility in the fed rat.

The effects of subcutaneous (s.c.), intraperitoneal (i.p.), intrathecal (i.t.) and intracerebroventricular (i.c.v.) injection of dermorphin (DER) on intestinal myoelectrical activity were examined in fed rats with chronically implanted electrodes on the small and large bowel. DER s.c. restored the 'fasting' pattern of duodenal activity, i.e., the migrating myoelectric complex (MMC), corresponding to an inhibition by about 40% of the fed pattern for 120 min at a dose as small as 0.5 nM per rat. DER i.p. strongly inhibited (about 65%) the fed pattern for 120 min. A fasting pattern lasting 80 min, or a marked inhibition lasting 150 min were recorded after 0.5 nM DER i.t. or i.c.v., respectively. On the contrary, the colonic pattern of activity was inhibited by DER whatever the route used, although the duration of inhibition was different from each other. For both the small and large intestine, similar doses of DER were more efficient by i.c.v. than by i.t. routes, and by i.p. than by s.c. routes. A plurality of sites of action is suggested, including local receptors which are activated, particularly at the duodenal level by i.p. DER (0.5 nM). The supraspinal component of the immediate effects of i.c.v. DER (0.1 nM) were demonstrated by a preferential effect on the colon that was even more intense than after i.t. DER.

Animals↗

PubMed1998

Controversy. The use of selective nerve root blocks: diagnostic, therapeutic, or placebo?

An increasing number of therapeutic spinal injections are performed each year despite little validation in randomized controlled trials. Additional injections are performed for diagnostic purposes of localizing symptomatic nerve roots, again without detailed evaluation of accuracy, specificity, or sensitivity. Drs. Slosar and White argue that selective nerve root blocks are extremely useful; Dr Wetzel believes that selective nerve root blocks have no role in selecting patients for surgery.

Humans↗

PubMed1996

[Compression stockings as prevention of hypotension in Cesarean section during spinal anesthesia].

Inflatable splints and wrapping of the legs have been shown to be effective against hypotension during spinal anaesthesia for Caesarean section. The aim of this study was to investigate if compression stockings could have a similar effect. Thirty healthy mothers scheduled for elective Caesarean section were randomised to have either compression stockings or no stockings on before spinal anaesthesia. The stockings had a pressure effect of 54 mmHg. The women were preloaded with 20 ml isotonic NaCl one hour preoperatively. Hypotension was defined as either a decrease in systolic blood pressure to 80% of preoperative values or systolic blood pressure under 100 mmHg. Blood pressure was measured every second minute, and ephedrine 5 mg was given in the presence of hypotension. Two patients were excluded in the control group. There were no differences in demographic data, extension of blockade, and spinal injection to delivery time. Nine patients in the group with stockings had either no fall in blood pressure or a fall in blood pressure corrected with only 5 mg ephedrine. In the control group the corresponding number was four patients (p < 0.12). Ephedrine dose between zero and 20 minutes and total ephedrine dose was significantly lower in the group with stockings than in the control group (p < 0.038). Five patients in the control group experienced nausea, no patients in the study group had nausea (p < 0.013). In conclusion, compression stockings stabilised the blood pressure during Caesarean section in spinal anaesthesia and led to a significant smaller need for ephedrine.

Adult↗

PubMed2001

Randomized controlled study of colloid preload before spinal anaesthesia for caesarean section.

We randomized women having elective Caesarean section to receive either no preload (control group, n=33) or 4% gelatin solution (Gelofusine) 15 ml kg(-1) (colloid group, n=35) i.v. before spinal anaesthesia. Intravenous metaraminol was titrated at 0.25-0.75 mg min(-1) to maintain systolic arterial pressure (SAP) in the target range 90-100% of baseline after the spinal injection. The control group required more vasopressor in the first 10 min [median 1.7 (range 0-2.9) mg vs 1.4 (0-2.8), P=0.02] at a greater maximum infusion rate [0.5 (0-0.75) vs 0.25 (0-0.5) mg min(-1), P=0.0005] and had a lower minimum SAP [90 (51-109) vs 101 (75-127) mm Hg, P=0.006] than the colloid group. Nausea was less frequent in the colloid group (6 vs 24%) but neonatal outcome was similar in the two groups. Colloid preload improved haemodynamic stability but did not affect neonatal outcome when arterial pressure was maintained with an infusion of metaraminol during spinal anaesthesia for Caesarean section.

Adult↗