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PubMed1999

A dose-response study of intravenous regional anesthesia with meperidine.

UNLABELLED: Intravenous regional anesthesia (IVRA) with meperidine in doses > or = 100 mg provides effective postoperative analgesia. However, this technique is associated with excessive opioid-related side effects, which limit its clinical usefulness. The minimal dose of meperidine that is effective for IVRA has yet to be established. We added 0, 10, 20, 30, 40, or 50 mg of meperidine to 0.5% lidocaine IVRA for either carpal tunnel or tenolysis surgery. Pain and sedation scores and the incidence of side effects were assessed in the postanesthesia care unit. The duration of analgesia, defined as the time to first request for pain medications, and use of acetaminophen/codeine (T3) tablets were measured. The duration of analgesia increased, in a dose-dependent manner, in the groups that received 0, 10, 20, and 30 mg of meperidine. There was no significant difference in the duration of analgesia for patients receiving > or = 30 mg of meperidine. T3 use was similar in the groups that received 0, 10, and 20 mg of meperidine and in the groups that received 30, 40, and 50 mg. T3 use was significantly lower in the larger dose groups. The incidence of sedation and of all other side effects was significantly higher in the groups that received 30-50 mg of meperidine compared with those that received smaller doses. We conclude that doses of meperidine large enough to produce the most effective postoperative analgesia with IVRA lidocaine causes a significant incidence of side effects, thus limiting its clinical usefulness. IMPLICATIONS: Meperidine may be a useful addition to 0.5% lidocaine for i.v. regional anesthesia. We showed that 30 mg is the optimal dose of meperidine with respect to postoperative analgesia. However, this dose caused a significant incidence of sedation, dizziness, and postoperative nausea and vomiting.

Adult↗
PubMed2004

A survey of orthopedic surgeons' attitudes and knowledge regarding regional anesthesia.

UNLABELLED: We conducted a survey to explore the surgical attitudes and preferences regarding regional anesthesia among Canadian orthopedic surgeons. Surveys were returned by 468 (61%) of 768 surgeons. Forty-eight percent of respondents directed their patients' choice of anesthetic. Forty percent of surgeons directed their patients to choose regional anesthesia. The principal reasons for favoring regional anesthesia were less postoperative pain (32%), decreased nausea and vomiting (12%), and safety (14%). Reasons for not favoring regional anesthesia were delays in the induction of anesthesia (43%) and an unpredictable success rate (12%). This survey suggests that orthopedic surgeons are supportive of regional anesthesia. Barriers to increased popularity include perceived delays and unreliability. IMPLICATIONS: Orthopedic surgeons understand the benefits of and are supportive of the use of regional anesthesia in their practices. Barriers to increased popularity include perceived operating room delays and lack of reliability.

Adult↗
PubMed2004

Visual sensation during phacoemulsification and intraocular lens implantation using topical and regional anesthesia.

PURPOSE: To evaluate patients' visual sensations at different stages of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation under topical and regional anesthesia. SETTING: Department of Ophthalmology, United Christian Hospital and Tseung Kwan O Hospital, Kowloon, Hong Kong, China. METHODS: Seventy-six consecutive patients having phacoemulsification were randomized to a topical anesthesia group (n = 35) or regional anesthesia group (n = 41). The topical anesthesia group received lidocaine hydrochloride 2% gel (Xylocaine) and the regional anesthesia group, a peribulbar or retrobulbar injection of lignocaine 2%. The patients' visual sensations, including light and color sensations, shape of objects, and visual patterns, were evaluated at different stages of surgery. RESULTS: Two patients (4.9%) in the regional anesthesia group and none in the topical anesthesia group experienced total loss of light sensation throughout surgery (P =.50). There was a significant association between color perception and the type of anesthesia at stages 1 and 2 (P<.05) but not at stages 3, 4, and 5 (P>.05). The perception of objects and visual patterns had no association with the type of anesthesia at any stage (P>.05). Of all patients in the study, 56 (73.7%) reported color changes as surgery proceeded. Both groups saw waves, defined as curves with periodic fluctuations in amplitude, at all stages. The perception of some colors and a rectangular moving object was significantly associated with the type of anesthesia at some or all stages (P<.05). CONCLUSIONS: Patients having phacoemulsification and PC IOL implantation under topical or regional anesthesia had a wide spectrum of visual sensations that were similar at most stages of surgery. Patients in the topical anesthesia group perceived more colors at the early stages and more blue throughout surgery than patients in the regional anesthesia group.

Aged↗
PubMed2000

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims.

PURPOSE: To review the pattern of malpractice litigation related to regional anesthesia in Canada. SOURCE: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997. PRINCIPAL FINDINGS: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. CONCLUSION: Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.

Anesthesia, Conduction↗
PubMed1984

Anesthesia associated depression in lymphocyte traffic: less with regional anesthesia than with general anesthesia in sheep.

In the sheep single peripheral lymph node model of Hall and Morris, it is possible to cannulate efferent and afferent lymphatic vessels for long-term study of cells and substances in lymph and for short- and long-term infusions. By supporting the sheep in sternal recumbency (upright) to avoid positional alterations in lymphocyte traffic in short-term studies and by precise timing and measurement of lymph output and cell counts, it is possible to accumulate data on lymphocyte output into efferent lymph on a consecutive, cumulative basis and to detect long- and short-term alterations in lymphocyte traffic. With this model, studies on the effects of general and regional anesthesia were carried out on 42 unstimulated primary peripheral lymph nodes of sheep in vivo. The lymphocyte traffic depressing effects of general anesthesia were found to be significantly less when regional epidural anesthesia was employed. The duration of depression also was less. In the general anesthesia studies, the depth of depression in lymphocyte traffic appeared related to the dose and length of anesthesia. These alterations may play important roles in the immunologic responses to anesthetic compounds and approaches.

Anesthesia, Epidural↗
PubMed1993

[Evaluation of a simplified protocol of local regional anesthesia for the surgery of the posterior segment].

A consecutive series of 100 patients with retinal detachment underwent surgery with local regional anesthesia (sedation plus peribulbar anesthesia). All patients were informed about the anesthesia alternatives (general and local regional) and the differences were explained. Ninety-seven patients chose local regional anesthesia. The remaining 3 patients had major contraindications for general anesthesia. The mean surgery time was 1 hour 25 minutes. Regional anesthesia failed in one case, and general anesthesia was then employed. Local regional anesthesia requires close collaboration of surgeon, anesthesiologist and patient. The main advantages of this technique are: its simplicity, the absence of oculocardiac reflex, diminution of pain, and the possibility of placing the patient in the desired position very shortly after surgery. The limitations of local regional anesthesia are: procedures that take longer time, and lack of patient comfort.

Adult↗
PubMed1988

Is there a place for regional anesthesia in pediatrics?--Yes!

Regional anesthesia has a central place in pediatrics. The neonate requires an analgesic, but not one which will produce respiratory depression. The older child undergoing intermediategrade surgery requires the best available analgesia, but without sedation and nausea. Regional techniques fulfil all these requirements. Caudal block is particularly useful and, even when given in large doses, does not give rise to high plasma concentrations. Regional techniques are seen at their best when combined with light general anesthesia. The advantages of both these methods are then available for the benefit of the child, and the value of regional analgesia is further enhanced when supplementary intramuscular or oral analgesia is given regularly at specific times so that pain is prevented rather than relieved.

Anesthesia, Conduction↗
PubMed1990

Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction.

The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large volumes of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12-14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia.

Absorption↗
PubMed2002

A new teaching model for resident training in regional anesthesia.

UNLABELLED: The adequacy of resident education in regional anesthesia is of national concern. A teaching model to improve resident training in regional anesthesia was instituted in the Anesthesiology Residency in 1996 at Duke University Health System. The key feature of the model was the use of a CA-3 resident in the preoperative area to perform regional anesthesia techniques. We assessed the success of the new model by comparing the data supplied by the Anesthesiology Residency to the Residency Review Committee for Anesthesiology for the training period July 1992-June 1995 (pre-model) and the training period July 1998-June 2001 (post-model). During the 3-yr training period, the pre-model CA-3 residents (n = 12) performed a cumulative total of 80 (58-105) peripheral nerve blocks (PNBs), 66 (59-74) spinal anesthetics, and 133 (127-142) epidural anesthetics. The CA-3 post-model residents (n = 10) performed 350 (237-408) PNBs, 107 (92-123) spinal anesthetics, and 233 (221-241) epidural anesthetics (P < 0.0001). All results are reported as median (interquartile range). We conclude that our new teaching model using our CA-3 residents as block residents in the preoperative area has increased their clinical exposure to PNBs. IMPLICATIONS: Inadequate exposure to peripheral nerve blocks has been a national problem. A teaching model instituted at Duke University Health System has resulted in a fourfold increase in exposure to peripheral nerve blocks compared with the national averages.

Anesthesia, Conduction↗
PubMed2005

Lift-(gasless) laparoscopic surgery under regional anesthesia.

The objective of this Chapter was to investigate the feasibility and outcome of gasless laparoscopy under regional anesthesia. A prospective evaluation of Lift-(gasless) laparoscopic procedures under regional anesthesia (Canadian Task Force classification II-1) was done at three endoscopic gynecology centers (franchise system of EndGyn(r)). Sixty-three patients with gynecological diseases comprised the cohort. All patients underwent Lift-laparoscopic surgery under regional anesthesia: 10 patients for diagnostic purposes, 17 for surgery of ovarian tumors, 14 to remove fibroids, and 22 for hysterectomies. All patients were operated without conversion to general anesthesia and without perioperative or anesthesiologic complications. Lift-laparoscopy under regional anesthesia can be recommended to all patients who desire laparoscopic intervention without general anesthesia. For elderly patients, those with cardiopulmonary risks, during pregnancy, or with contraindications for general anesthesia, Lift-laparoscopy under regional anesthesia should be the procedure of choice.

Anesthesia, Conduction↗
PubMed1977

[Indications and contraindications of regional anesthesia (author's transl)].

A short introduction about common techniques of regional anesthesia and statistical data about the percentage of such procedures carried out in our institute are presented. Important techniques and aims of regional anesthesia are clearly pointed out. The results of our study are discussed in detail, as are the advantages, disadvantages, indications, and contraindications of regional anesthesia. Finally the paper concludes with our impression of regional anesthesia, its significance and status in China.

Adult↗
PubMedDate not supplied

Emery A. Rovenstine and regional anesthesia.

BACKGROUND AND OBJECTIVES: Emery Andrew Rovenstine was a dominant figure in anesthesiology in the United States between 1935 and 1960. Among his many contributions to the specialty, his regional anesthesia practice remains less well known. This paper explores Rovenstine's career and his contributions to regional anesthesia. METHODS: Original documents studied and classified for this investigation included all of Rovenstine's published papers and the extant documents of the original American Society of Regional Anesthesia. Interviews with several physicians who knew Rovenstine were conducted. Secondary source materials, including biographies of Rovenstine, were perused. RESULTS: Rovenstine made a major contribution to regional anesthesia through patient care, teaching, and political action. Many of his students went on to become leaders in anesthesiology and emphasized regional anesthesia in the second half of the twentieth century. CONCLUSIONS: Emery A. Rovenstine did much to popularize regional anesthesia and ensure a rightful place for its techniques within the armamentarium of the anesthesiologist. Keeping alive the traditions of Gaston Labat at Bellevue, Rovenstine's contributions to regional anesthesia on all levels were considerable. Most importantly, he ensured an enduring role for regional anesthesia through the recurring contributions of his pupils.

Anesthesia, Conduction↗
PubMed1992

Regional anesthesia for foot and ankle surgery.

We present our experience with the use of regional anesthesia in 1295 of 1862 (69.5%) surgical procedures of the foot and ankle between 1986 and 1989. Regional anesthesia was used for surgical procedures of the forefoot, midfoot, hindfoot, and ankle in the setting of elective surgery and trauma. From the viewpoint of the surgeon, regional anesthesia was completely successful in 95% of the procedures performed. Sample patient surveys confirmed that 87% of patients were satisfied with the use of regional anesthesia for their operative procedure. There were four (0.3%) minor complications, one being lidocaine toxicity. With increasing experience, the expanded indications and uses of regional anesthesia for foot and ankle surgery are proving to be simple, safe, reliable, and well tolerated by the patient.

Adolescent↗
PubMed1993

Anesthesia and blood loss in preterm cesarean section: comparison between general and regional anesthesia.

Changes in maternal hemoglobin concentrations after cesarean section performed before 35 weeks gestation were analyzed according to the type of anesthesia in a case-control retrospective study. There were 30 mothers who received general anesthesia (GA group) and 30 mothers who received regional anesthesia (RA group). The groups were matched for gestational age at delivery, type of uterine incision, and the use of tocolytic therapy (isoxuprine) before delivery. The indications for delivery were preterm labor or fetal/maternal complications following premature rupture of membranes without labor. There was no significant difference between the GA and RA groups in the pre-operative hemoglobin (11.9+/-1.4 vs 11.6+/-1.1 g/dl) or postoperative hemoglobin (11.1+/-1.7 vs 11.3+/-1.2 g/dl). The GA group, however, demonstrated a significant fall in the postoperative hemoglobin (P < 0.05). The GA group also had a higher incidence of a drop in hemoglobin of > 10% compared to the RA group (46.7% vs 20.0%, P < 0.05). Our results suggest that general anesthesia may be associated with more blood loss than regional anesthesia in cesarean sections performed before 35 weeks.

Journal Article↗
PubMed1997

Serious complications related to regional anesthesia: results of a prospective survey in France.

BACKGROUND: Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of regional anesthetics, using preplanned criteria to measure the incidence and characteristics of associated serious complications. METHODS: Requests were sent to 4,927 French anesthesiologists in advance of a subsequent 5-month study period. Participating anesthesiologists were asked for detailed reports of serious complications occurring during or after regional anesthetics performed by them during the study interval. Details regarding each complication then were obtained via a second questionnaire. RESULTS: The number of responding anesthesiolgists was 736. The number of regional anesthetics performed was 103,730, corresponding to 40,640 spinal anesthetics, 30,413 epidural anesthetics, 21,278 peripheral nerve blocks, and 11,229 intravenous regional anesthetics. Reports of 98 severe complications were received, with follow-up information being obtained for 97. In 89 cases, complications were attributed fully or partially to regional anesthesia. Thirty-two cardiac arrests, seven of which were fatal, occurred during the study. Of these, 26 occurred during spinal anesthesia, with 6 being fatal, 3 occurred during epidural anesthesia, and 3 more occurred during peripheral blocks. The higher incidence of cardiac arrest during spinal anesthesia (6.4 +/- 1.2 per 10,000 patients) compared with all other regional anesthesia (1.0 +/- 0.4 per 10,000 patients) was statistically significant (P < 0.05). Of 34 neurologic complications (radiculopathy, cauda equina syndrome, paraplegia), 21 were associated either with paresthesia during puncture (n = 19) or with pain during injection (n = 2), suggesting nerve trauma or intraneural injection. Twelve patients who had neurologic complications after spinal anesthetics had no paresthesia during needle placement and no pain on injection. Of these 12 patients (7 with radiculopathy and 5 with cauda equina syndrome), 9 received intrathecal hyperbaric lidocaine, 5%. The incidence of neurologic injury was significantly greater after spinal anesthesia (6 +/- 1 per 10,000 cases; P < 0.05) than after each of the other types of regional procedures (1.6 +/- 0.5 per 10,000 cases for the weighted average). Seizures attributed to elevated serum levels of local anesthetics occurred in 23 patients, but none suffered a cardiac arrest. CONCLUSIONS: (1) The incidence of cardiac arrest and neurologic injury related to regional anesthesia were very low, but both were more than three SDs greater after spinal anesthesia than after other regional procedures. (2) Two thirds of the patients with neurologic deficits had either a paresthesia during needle placement or pain on injection. (3) Seventy-five percent of the neurologic deficits after nontraumatic spinal anesthesia occurred in patients who had received hyperbaric lidocaine, 5%.

Adult↗