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At least 127 records · Page 7Linked to original sources
PubMed2001

Vascular orientation by intra-arterial dye injection during spinal arteriovenous malformation surgery.

OBJECTIVE: Rich and complicated vascular structures on the spinal cord often interfere with obliteration of a spinal arteriovenous malformation (AVM). Vascular orientation during spinal AVM surgery is essential. The authors recently performed six consecutive spinal AVM surgeries in five patients (two with perimedullary AVMs, and three with dural arteriovenous fistulae) with the aid of intra-arterial injection of dye (indigo carmine). METHODS: Two representative cases are described. A microcatheter was placed preoperatively in the artery of interest. Subsequent to the exposure of the vascular complex, a 1-ml injection of indigo carmine (2 mg/ml) clearly demonstrated the feeding arteries and the draining veins around the AVM or dural arteriovenous fistula. RESULTS: One patient had repeat surgery because of incomplete obliteration of the AVM owing to migration of the catheter. All patients, except one who had temporary postoperative deterioration and persistent neurological deficits, had good surgical outcomes, however. No apparent side effects caused by the dye were reported. CONCLUSION: The assistance system for spinal AVM surgery is easy and safe and can be applied in other surgical institutions.

Angiography↗
PubMed2000

Patients' perceptions of pain with spinal, intramuscular, and venous injections.

Most of 46 patients believed that spinal injection would be more painful than intramuscular or intravenous injections. The reverse proved true: spinal injections were perceived to be less painful than the other two procedures. Intramuscular injections should be avoided. Local anaesthesia should be given for lumbar punctures and intravenous cannulation.

Adolescent↗
PubMed2005

[Hypothermia after spinal anaesthesia: implication of morphine?].

Spinal anaesthesia is the gold standard for elective caesarean section. This technique presents several adverse effects. We report a severe case of hypothermia (33.3 degrees C) after spinal administration of bupivacaine (10 mg) and morphine (100 microg) for elective caesarean section. After excluding other causes of hypothermia, this one could be explained by both the own effects of local anaesthesia (i.e. peripheral vasodilatation) and by the central effect of intrathecal morphine. Because hypothermia is not predictable after spinal injection of morphine both monitoring of central temperature and active warming of the patients could be proposed. Naloxone has been proposed in a case of hypothermia related to spinal injection of morphine.

Adult↗
PubMed1990

Extracellular labeling of unmyelinated dorsal root terminals after WGA-HRP injections in spinal ganglia.

Wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) is a widely used neuroanatomical tracer. When compared with other tracers, WGA-HRP may preferentially label unmyelinated fibers. In agreement with this hypothesis, injections of WGA-HRP in cervical and lumbar dorsal root ganglia resulted in more prominent light microscopical labeling in superficial than deep laminae of the dorsal horn. However, ultrastructural examination of these laminae reveals a paucity of terminal labeling in contrast to the abundance of extracellular tracer in the space surrounding unmyelinated fibers and their terminals, and to the widespread occurrence of transneuronal labeling. These results bear upon the mechanism of preferential labeling in the spinal cord and have implications for the interpretation of the labeling obtained when using WGA-HRP.

Animals↗
PubMed2005

Incidence of vocal cord dysfunction after fluoroscopically guided steroid injections in the axial skeleton.

OBJECTIVE: To report on the incidence of dysphonia and/or associated throat symptoms after steroid injections in the axial skeleton. DESIGN: A prospective cohort study. SETTING: Academic spine center. PARTICIPANTS: Patients (N = 100) undergoing a diagnostic injection followed by a therapeutic injection in the axial skeleton. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Presence or absence of dysphonia and/or associated throat symptoms, as determined by completion of a predetermined 10-item questionnaire. This questionnaire was administered before participation in the study and at specific intervals after a diagnostic injection and, again, after a therapeutic spinal injection. RESULTS: There was a 12% incidence of transient dysphonia and/or associated throat symptoms in this study population after a therapeutic injection. CONCLUSIONS: Throat symptoms are a potential, albeit transient side effect, after an epidural space corticosteroid injection. The mechanism through which dysphonia or other throat symptoms develop is unknown but appears to be mediated by a systemic steroid effect.

Adult↗
PubMed1994

Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep.

INTRODUCTION: Epidural and spinal injection of alpha 2-adrenergic agonists causes analgesia and hypotension. For opioids, relative analgesic potency of epidural to intravenous administration decreases with increasing lipophilicity, but such pharmacodynamic studies have been performed with only one alpha 2-adrenergic agonist, clonidine, of moderate lipophilicity. This study examines antinociception, transfer to cerebrospinal fluid (CSF), and CSF pharmacokinetics in sheep of the selective alpha 2-adrenergic agonist dexmedetomidine, with lipophilicity 3.5 times greater than clonidine, and correlates CSF concentrations to hemodynamic effects. METHODS: Six sheep with chronically implanted epidural, intrathecal, and vascular catheters received, on separate days, 100 micrograms dexmedetomidine intravenously, epidurally, or intrathecally. Cerebrospinal fluid and blood were sampled at specified intervals for dexmedetomidine assay. Pharmacokinetics of dexmedetomidine in CSF were determined using a NONMEM approach. Hemodynamic effects were measured and correlated to CSF concentrations. A second group of four sheep received intrathecal dexmedetomidine to define its time course for antinociception. RESULTS: Intrathecal dexmedetomidine decreased blood pressure within 1 min, with a maximum reduction of -22 +/- 3%. Epidural injection decreased blood pressure with a slower onset (11 min) and to a lesser degree (-14 +/- 4%), whereas intravenous injection did not affect blood pressure (-8 +/- 6%). Dexmedetomidine absorption in CSF after epidural injection was rapid (Tmax = 5-20 min), although pharmacokinetic modeling suggested a biphasic absorption process. Only 22% of the injected dose was identified in the CSF. There was a delay of at least 30 min between peak CSF concentrations and time of maximal reduction in blood pressure. At times of identical CSF dexmedetomidine concentrations, blood pressure decreased more after epidural than after intrathecal administration. Intrathecal dexmedetomidine injection produced maximum antinociception within 20-30 min of injection. CONCLUSIONS: These data support a primary spinal site of action for decreased blood pressure after intraspinal dexmedetomidine injection. Dexmedetomidine appears rapidly in CSF after epidural administration and decreases blood pressure. The relationship between CSF dexmedetomidine concentrations and drug effect may require more complex modeling tools than those used to relate plasma drug concentrations to effects of systemically administered opioids or neuromuscular blockers.

Adrenergic alpha-Agonists↗
PubMed2005

Small-dose bupivacaine-sufentanil prevents cardiac output modifications after spinal anesthesia.

Spinal injection of small-dose (SD) bupivacaine decreases the likelihood of hypotension compared with large-dose (LD) bupivacaine. We assumed that a SD of bupivacaine could also prevent the decrease in cardiac output (CO). Patients undergoing elective urologic, lower abdominal, or lower limb surgery under spinal anesthesia were included in this prospective randomized study. Spinal injection consisted of 5 mug of sufentanil and either SD (7.5 mg of hyperbaric bupivacaine with glucosemonohydrate 80 mg/mL; n = 19 patients) or LD (12.5 mg of hyperbaric bupivacaine with glucosemonohydrate 80 mg/mL; n = 19 patients). CO (impedance cardiography), arterial blood pressure, and heart rate) were measured at 1 min before performance of spinal block and 2, 10, and 30 min after the intrathecal injection. Sensory level was also assessed at 30 min. CO was higher in the SD group as compared with the LD group from 2 min to 30 min after spinal anesthesia. Moreover, CO increased at 2 min in the SD group and decreased at 10 and 30 min in the LD group compared with baseline value. In conclusion, SD bupivacaine provides successful anesthesia and gives better CO stability than LD.

Adult↗
PubMed2005

Disk entry: a complication of transforaminal epidural injection--a case report.

Correctly identifying the etiology of low back pain can be challenging. The importance of making an expedient, accurate diagnosis of lumbar radicular pain cannot be overemphasized, as proper treatment is based on the outcome. The application of fluoroscopically guided, contrast enhancement during spinal injections is commonly performed, but is not without complications. Intradiskal placement of contrast dye during lumbar transforaminal epidural injection is important to identify, as serious potential complications, such as diskitis, may occur. Additionally, postprocedure assessment may not be accurate if contrast placement is not correctly identified. This case report reviews the literature on complications of transforaminal steroid injection and presents the first documentation of intradiskal placement of contrast dye in the United States. A 72-year-old man presenting with a right L4 radiculopathy underwent a fluoroscopically guided, contrast-enhanced lumbar transforaminal epidural steroid injection and experienced intradiskal placement of contrast as a complication of this procedure. Although the patient was treated prophylactically and achieved good results, the need for fluoroscopy and contrast enhancement during performance of spinal injections is reemphasized.

Aged↗
PubMed2002

Prevention of phantom sensations after spinal anesthesia.

BACKGROUND AND OBJECTIVES: Phantom limb sensation (PLS) after the spinal anesthesia is an unpleasant experience. The occurrence rate was 80 to 83 per cent from previous studies. The purpose of this study is to evaluate the incidence of PLS, comparing between placing the lower limbs in the neutral position when analgesic level reach L1 dermatome (L1 group) and T6 dermatome (T6 group). METHODS: Ninety ASA physical status I-II patients, 19-50 year of age, scheduled for lower abdominal surgery under spinal anesthesia were enrolled. Immediately after the spinal injection, the patients were placed supine with one of lower limbs flexed (both hip and knee) and the other kept straight in the neutral position. The analgesic levels were checked every minute; the flexed limbs were turned to the neutral position when the analgesic level reached L1 and T6, the L1 group and the T6 group respectively. The images of the lower limbs and patients' satisfactions were evaluated 15 minutes after the blockage. RESULTS: Twenty per cent of the patients in the L1 group experienced PLS of the flexed limbs while 82.2 per cent of the patients in the T6 group did (P<0.05). None of the patients in the L1 group felt unsatisfied with PLS, on the other hand, 11.1 per cent of the patients in the T6 group expressed their dissatisfaction and would like to have their limbs extended. CONCLUSIONS: This study revealed that by placing the lower limbs in the neutral position immediately after the spinal injection, before the unwanted positions are memorized, could effectively minimize phantom limb sensation after spinal anesthesia.

Adult↗
PubMed1998

Effect of orifice-area reduction on flow characteristics during injection through spinal needles.

A reduction in hole size for certain side-port spinal needles has been advocated in recent reports. While the influence of orifice-area reduction on the aspiration capability of the needle has been studied, the influence on the anaesthetic delivery properties is relatively unknown. As a first step in understanding the effects of hole-size reduction on anaesthetic distribution within the subarachnoid space, we studied flows emanating from isolated needles using computer simulations. Following validation of the numerical model using experimental particle visualisation, trajectories of anaesthetic particles injected through 25 G Whitacre needles of various orifice areas were computed and used to determine the orientation and rate of spread of the anaesthetic jet exiting the needle. Two factors impacting the concentration distribution were observed: the rate of spread of the anaesthetic jet increases markedly with decreasing orifice area and the jet alignment shifts toward perpendicular to the needle axis.

Anesthesia, Spinal↗
PubMed2006

Low-dose combined spinal-epidural anesthesia for cesarean delivery: a comparison of three plain local anesthetics.

The new local anesthetics have been poorly studied for intrathecal use during Cesarean section surely in low doses and in combination with an opioid substance. The purpose of the present study was to compare bupivacaine and the newer local anesthetics in equipotent doses. During the induction of combined spinal-epidural anesthesia, 91 elective Cesarean section patients were randomly assigned to receive a spinal injection of either 10 mg ropivacaine or 6.6 mg bupivacaine or levobupivacaine both combined with sufentanil 3.3 microg. After securing the epidural catheter patients were turned to the supine position respecting a 15 degrees left lateral tilt. The three local anesthetics were compared with respect to sensory and motor block, the need for epidural supplementation, the severity of hypotension and neonatal outcome. More patients in bupivacaine had a Bromage-3 motor block at incision. The ropivacaine group required additional local anesthetics by the epidural route in 23% of the cases versus 10% in the bupivacaine group and 9% with levobupivacaine. This caused the interval between the spinal injection and the end of surgery to be longer in the ropivacaine group. Hemodynamic values were comparable between the three groups although a trend towards better systolic blood pressures and a lower incidence of severe hypotension were noticed in favor of levobupivacaine. Apgar scores and umbilical pH values did not differ. When performing a low-dose combined spinal-epidural technique for Cesarean section, the present study confirms that the new local anesthetics can be used successfully, induce less motor block but that ropivacaine requires at least a 50% larger dose than bupivacaine or levobupivacaine.

Adjuvants, Anesthesia↗
PubMed1997

Peri-operative multimodal pain therapy for caesarean section: analgesia and fitness for discharge.

PURPOSE: To compare, the efficacy of a multi-modal analgesic regimen and single drug therapy with iv PCA morphine alter Caesarean delivery with spinal anaesthesia. METHODS: Forty ASA 1-2 parturients presenting for elective Caesarean section were randomized to receive multimodal pain treatment with intrathecal morphine, incisional bupivacaine and ibuprofen+acetaminophen po until hospital discharge (Group 1) or conventional therapy with iv PCA morphine weaned to acetaminophen+codeine po (Group 2). Both groups received spinal anaesthesia with 1.7 ml hyperbaric bupivacaine 0.75%. Visual analog pain scores at rest (RVAPS) and with movement (DVAPS) were recorded q 2 hr during the first 24 hr, then q 4 hr until discharge. Time to first walking, eating solid food, flatus, bowel movement, voiding and hospital discharge were recorded. RESULTS: Pain scores were lower in Group 1 patients during the first 24 hr after spinal injection RVAPS 0.6 +/- 0.1 in Group 1 vs 2.1 +/- 0.1 in Group 2 (mean +/- SEM), DVAPS 1.9 +/- 0.1 in Group 1 vs 4.1 +/- 0.1 in Group 2 (P < 0.0001). Times to first flatus, 36.1 hr +/- 2.9 vs 20.5 +/- 1.8 (P < 0.05) and to first bowel movement, 74.8 hr +/- 5.6 vs 57.4 +/- 4.7 (P < 0.0001) were longer in Group 2 patients. There was no difference between groups in time to eating solid food, walking or hospital discharge. CONCLUSION: Multi-modal pain therapy resulted in improved early post-operative analgesia during the first 24 hr after Caesarean delivery. Patients receiving iv PCA morphine followed by acetaminophen+codeine po were more likely to develop decreased bowel mobility. All patients, with one exception, achieved discharge criteria (eating solid food, absence of nausea, normal lochia, dry incision and DVAPS < 4) at 48 hr after spinal injection.

Analgesia, Obstetrical↗
PubMed2006

Urinary catheterization may not be necessary in minor surgery under spinal anesthesia with long-acting local anesthetics.

BACKGROUND: This prospective study was designed to compare the incidence of urinary retention after spinal anesthesia between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in patients who underwent minor orthopedic and general surgeries. METHODS: Eighty patients aged 18-40 were randomly assigned to receive either hyperbaric bupivacaine or tetracaine for spinal anesthesia. Intravenous fluids were administered for maintenance of basal requirement, replacement of blood loss and prevention of hypotension. The highest level of analgesia, regression time of sensory block to L5 level, length of time from spinal injection to spontaneous urinary voidance, and volume of perioperative fluid administered were recorded. RESULTS: Of the 80 patients who received either hernioplasty, fistulectomy, hemorroidectomy or orthopedic surgery, two were catheterized (2.5%) because of urinary retention. They were administered less than 800 mL of fluid intraoperatively. Intraoperative blood loss was less than 100 mL in all cases. There were no statistical differences in demographic data, types of surgery, sensory blockade and perioperative fluid administration between the two groups. Although the regression time of sensory blockade with tetracaine (means +/- SD, 259.3 +/- 39.6 min) was significantly longer than that of bupivacaine (225.0 +/- 38.6 min, P < 0.01), the time elapsing from the spinal injection to the first spontaneously voiding after surgery did not show statistical difference between two groups (433.9 +/- 89.1 vs. 411.0 +/- 98.3 min, P = 0.286). CONCLUSIONS: Our results show that, in younger surgical patients who did not receive large amount of fluid intraoperatively, the incidence of urinary retention was low, although prolonged sensory blockade by both long-acting local anesthetics was evident. Thus, urinary catheterization should not be a routine must for every patient undergoing minor surgery with long-acting spinal local anesthetics. From the viewpoint of financial expense, avoidance of complication and annoyance of urinary catheterization, careful observation of urinary bladder fullness in the form of lower abdominal distension, discomfort, bradycardia, or vomiting after surgery is superior to routine retention urinary catheterization just for ease with work in younger patients under-going minor surgery under long-acting spinal local anesthetics.

Adult↗