Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for the Effects of Enhanced Recovery after Cesarean Section / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of programmed intermittent epidural bolus （PIEB） and continuous epidural infusion （CEI） on enhanced recovery after cesarean section. MethodsTotally 120 women scheduled to undergo elective cesarean section under combined spinal and epidural anesthesia， aged 18-45 years， with single fetus， full-term pregnancy （≥37 weeks）， ASA grade II or III， were recruited， with 60 cases in each group. At the end of the surgery， after a similar epidural loading dose， patients were randomLy assigned to receive either PIEB （6 mL·h-1 beginning 30 minutes after the loading dose） or CEI （6 mL·h-1， beginning immediately after the loading dose） for the maintenance of analgesia with 0.1% ropivacaine. At 2， 6， 12， 24 and 36 h postoperatively， VAS score was used to evaluate the composite pain， and Bromage Score was used to evaluate the degree of lower extremity motor block. The time to first flatus， time to first ambulation and the satisfaction scores were also recorded. ResultsThe VAS scores at 12， 24 and 36 h postoperatively and the lower extremity motor block scores at 6， 12 and 24 h postoperatively in the PIEB group were significantly lower than those in the CEI group （P < 0.01）. The epidural analgesic dosage was less in the PIEB group than that of the CEI group （P=0.002）. The time to first flatus and time to first ambulation were significantly shorter than those in the CEI group （P < 0.05）. The satisfaction scores were significantly higher in the PIEB group than in the CEI group （P < 0.05）. There was no significant difference in the first urination time after urinary catheter removal and the length of hospital stay between the two groups （P > 0.05）. ConclusionCompared with CEI， PIEB provides better postoperative analgesia， less motor block scores， lower epidural analgesic dosage， shorter the time to first flatus and defecation and time to first ambulation， and greater patient satisfaction， which is more consistent with the ERAS concept of analgesia.

Comparison of 0.75 % Ropivacaine with 0.5 % Bupivacaine in Peribulbar Block in Ophthalmic Surgeries

Bupivacaine as local anaesthetic has cardiovascular and neurological toxic effects; ropivacaine on the other hand is known to have fewer side effects. Its safety and some its ability to reduce intra ocular pressure has led to its widespread usage. The aim of our study was to compare the efficacy of inj. Ropivacaine 0.75 % + hyaluronidase 50 IU / mL with inj. bupivacaine 0.5 % + hyaluronidase 50 IU / mL in cataract surgeries under regional anaesthesia. MethodsWe evaluated 60 patients who were posted for small incision cataract surgeries. They were randomly divided by drawing chits in to 2 groups according to the anaesthetics used (ropivacaine / bupivacaine). Evaluation of these patients was done on the basis of sensory onset, motor onset using akinesia score, requirement of rescue analgesic, and time of motor and sensory offset of the local anaesthetic. ResultsInj. ropivacaine 0.75 % showed greater reduction in IOP (p < 0.05). Other parameters such as motor block, sensory block, akinesia score, and requirement of rescue analgesia were comparable between the two groups (p > 0.05). ConclusionsIn patients posted for intra ocular / cataract surgeries, ropivacaine 0.75 % and bupivacaine 0.5 % are comparable, with ropivacaine having better haemodynamic profile and also reduces intra ocular pressure.

Bloqueio motor e sensitivo da lidocaína ou da ropivacaína peridural em cães / [Motor and sensitive blockade provided by epidural lidocaine or ropivacaine in dogs]

Objetivou-se avaliar o bloqueio sensitivo e motor da administração peridural de 0,2mL/kg de duas concentrações de ropivacaína em comparação à lidocaína em cães. Utilizaram-se 24 cães, distribuídos em quatro grupos: NaCl a 0,9% (GS), lidocaína a 2% (GL), ropivacaína a 0,5% (GR5) e ropivacaína a 0,75% (GR7,5). Avaliaram-se a presença de movimentação espontânea, deambulação, sensibilidade superficial e profunda nos momentos cinco, 10, 15, 20, 25, 30, 45, 60, 90, 120, 180, 240 e 300 minutos após peridural. O retorno à movimentação espontânea foi semelhante entre GL (42,50 ± 6,12) e GR7,5 (69,2 ± 58,9). O tempo para deambulação foi mais prolongado em GR7,5 (107,5 ± 79,3) que em GS (9,2 ± 3,8) e em GR5 (32,5 ± 20,9). O retorno da sensibilidade profunda foi maior em GR 7,5 (152,5 ± 89,2) que em GS (5,8 ± 2,0), GR5 (46,7 ± 46,3) e GL (52,5 ± 20,7). O tempo de retorno da sensibilidade superficial foi maior em GR7,5 (205,0 ± 129,3) que em GS (7,5 ± 2,7), GL (72,5 ± 19,9) e GR5 (97,5 ± 55,1). Apesar do retorno precoce da movimentação, ropivacaína 0,75% está relacionada a tempo prolongado de recuperação da função muscular e bloqueio sensitivo mais prolongado que lidocaína e ropivacaína 0,5%.(AU)

The aim of the present study was to evaluate the sensory and motor blockade of epidural 0.5% and 0.75% Ropivacaine or Lidocaine in dogs. Twenty-four dogs were distributed in four groups: 0.9% NaCl (GS), 2% lidocaine (GL), 0.5% ropivacaine (GR5) and 0.75% ropivacaine (GR7.5). Spontaneous movement, ability to walk, superficial, and deep pain response were assessed 5, 10, 15, 20, 25, 30, 45, 60, 90, 120, 180, 240 and 300 minutes after epidural. Time to return to spontaneous movement was similar between GL (42.50 ± 6.12) and GR7.5 (69.2 ± 58.9). Time to return to ambulation was longer in GR7.5 (107.5 ± 79.3) than in GS (9.2 ± 3.8) and GR5 (32.5 ± 20.9). Time to recover deep sensitivity was longer in GR 7.5 (152.5 ± 89.2) than in GS (5.8 ± 2.0), GR5 (46.7 ± 46.3) and GL (52.5 ± 20.7). Time to return superficial sensitivity was longer in GR7.5 (205.0 ± 129.3) when compared to GS (7.5 ± 2.7), GL (72.5 ± 19.9) and GR5 (97.5 ± 55.1). Despite the early return of spontaneous movement, 0.75% ropivacaine is related to longer periods for muscle function recovery and longer sensory block than lidocaine and 0.5% ropivacaine.(AU)

Comparative Analysis of the Efficacy of Epidural Dexmedetomidine and Clonidine with Bupivacaine in Patients Undergoing Infraumbilical Surgeries

Introduction: Pain was defined by Mountcastle in the year1968 as “that sensory experience evoked by stimuli thatinjures”. It is a subjective feeling and failure to relieve pain inany procedure cannot be accepted, both ethically and morally,and adequate pain relief must be treated as basic human right.Pain relief both in peri-operative and post-operative period isthe crux of anaesthesia. The aim of the study was to evaluatethe efficacy of epidural Dexmedetomidine and Clonidine as anadjuvant to Bupivacaine in patients undergoing infraumbilicalsurgeries.Material and Methods: Seventy (70) patients aged 20-60years (ASA I-II) undergoing infraumbilical surgery wererandomly allocated to two groups- Group BD receivingepidurally 15ml Bupivacaine (0.5%) + Dexmedetomidine(1mg/kg) and Group BC receiving 15ml Bupivacaine (0.5%)+ Clonidine (1mg/kg). After securing I/V line, infusionstarted with R/L and under strict aseptic condition, patientswere administered epidural block via 18G Tuohy needlein the sitting or lateral position at L3-L4 intervertebralspace.Results: We observed that the time taken for the onset ofsensory block at T10 level, time for sensory block upto T6 andthe time taken for maximum motor block is less in Group BDcompared to Group BC. Regarding the post-operative block,the time to sensory two segment regression, time to sensoryregression to S1, time for recovery of motor block and timeto first rescue analgesia were more in Group BD compared toGroup BC. And the difference between the two groups weresignificant (p<0.001).Conclusion: On the basis of the findings of our present clinicalstudy, we can come to conclusion that Dexmedetomidine ismore effective epidural adjuvant compared to Clonidine inpatients undergoing infraumbilical surgery.

The best route and dose of dexamethasone for brachial plexus block: A systematic review and meta-analysis / 中国组织工程研究

BACKGROUND: Dexamethasone has been widely used in brachial plexus block to enhance the block effect but the best way (perineural or intravenous) and dose are still inconclusive. OBJECTIVE: To systematically evaluate the optimal approach and dose of dexamethasone for brachial plexus block. METHODS: Studies on dexamethasone and brachial plexus block were searched in PubMed, Embase, Cochrane Library, CNKI, WanFang and VIP. Two evaluators analyzed the literatures, evaluated the quality, extracted relevant research indicators according to the screening criteria, and completed the meta-analysis. RESULTS AND CONCLUSION: A total of 16 articles were finally included in the meta-analysis (1 260 patients). As suggested by the Meta-analysis, regardless of 1-4 mg or 5-10 mg of dexamethasone, the perineural group significantly prolonged the duration of analgesia compared with the intravenous group [weighted mean difference (WMD)=201.38, 95% confidence interval (CI) (68.22, 334.54), P=0.003; WMD=302.96, 95%CI (142.41, 463.50), P=0.000 2]. There were no significant differences in the duration of motor block between the perineural and intravenous groups [WMD=121.06, 95%CI(-62.31, 304.42), P=0.20, I 2 =95%]. Compared with the intravenous group, the perineural group significantly prolonged the duration of analgesia. However, similar duration of analgesia was found in 1-4 mg and 5-10 mg of dexamethasone and the analgesia effect did not increase with the increase of dose. There were no significant differences in the duration of motor block between the perineural and intravenous groups.

A comparative study on the effectiveness of bupivacaine and ropivacaine for supraclavicular block

Background: Bupivacaine and Ropivacaine have been extensively studied &their properties with respect to onset, duration and quality of block. This study aims to detect whether addition of clonidine to both of them changes their properties. This study also aims to use lower than usual dosages for both the local anesthetics to prevent adverse effects of local anesthetics.Methods: After obtaining ethical approval, the study was carried out on patients undergoing elective upper limb surgeries. They were randomly divided into two Groups: Group B and Group R. The onset and duration of sensory and motor blockade and other parameters were assessed.Results: The onset of blockade, both sensory & motor was earlier in Ropivacaine as compared to Bupivacaine group. Mean duration of blockade, both sensory & motor, was more in the Bupivacaine group.  Conclusions: Addition of Clonidine enabled the use of low concentrations (0.25%) of both the anesthetics. Also, Ropivacaine (0.25%) has faster onset of sensory and motor blockade, shorter duration of action and less motor blockade compared to Bupivacaine.

A comparative evaluation of effect of intravenous premedication with ondansetron versus granisetron on hemodynamics and sensory-motor blockade produced by intrathecal hyperbaric 0.5% bupivacaine

Background: Bezold Jarisch reflex is important cause of hypotension and bradycardia which occur after spinal anaesthesia. This reflex is elicited by stimulation of peripheral serotonin receptors 5- hydroxytryptamine (5- HT3 type). These receptors have antinociceptive effect, which is confirmed by many studies.The two most commonly used 5HT3 antagonist are ondansetron and granisetrone. Very few comparative studies of the two drugs on the effect after spinal anaesthesia are available.Methods: Ninety adulted patients of either sex aged 18-58 years scheduled for elective infraumbilical surgeries were randomly allocated in three groups to receive intravenous ondansetron 4mg, granisetrone 2mg or normal saline in equal volume 5mins before spinal anesthesia. Hemodynamic changes and time to sensory motor onset and regression were evaluated.Results: There was statistically significant difference in fall of systolic diastolic and mean blood pressure among the three groups. Time to two segment regression of sensory block and time to regression to S1 was faster in ondansentron (76.6±17.2mins, 176±22mins) and granisetrone group (69±17.3mins, 165±19.2mins) in comparision to control group(77.4±24.3mins, 178±21mins) which was statistically significant also p value-0.019, 0.0001 respectively.Conclusions: The prophylactic therapy with 4mg i.v. ondansetron, given five minutes before spinal anaesthesia appears to be significantly most effective and safe for attenuating haemodynamic response after spinal anaesthesia without affecting the duration of sensory block in patients undergoing infraumbilical surgeries.

Comparison of analgesic properties of perineural and systemic dexamethasone in patients undergoing upper limb surgeries under supraclavicular block

Introduction: Pain in the postoperative period is the distressing period after any surgeries particularly in the first 24 hours. Postoperative pain is associated with an increase in sympathetic activity leading to increases in heart rate, blood pressure, respiratory rate and even delirium and myocardial insults. Opioids and NSAIDS are very commonly used in the postoperative period in spite of their known adverse effects. So there is a need for a study to find a drug which prolongs the duration of analgesia in the postoperative period without many side effects so that usage of opioids and NSAIDS drugs in the first 24 hours can be decreased. The aim of the study: To compare during supraclavicular brachial plexus block, the single perioperative dose of intravenous Dexamethasone and perineural Dexamethasone effects on onset and duration of sensory and motor blockade ; quality of analgesia and reduction in the dose of opioids in first 24 hour. Materials and methods: A Randomized, Triple-Arm, Double-Blind, Placebo-Controlled Trial. Totally 90 patients were recruited in the study patients undergoing upper limb surgeries under supraclavicular block at govt. Kilpauk medical college hospital and govt. Royapettah Hospital from Sathyan Natarajan, Karthikeyan G, Murugan T. Comparison of analgesic properties of perineural and systemic dexamethasone in patients undergoing upper limb surgeries under supraclavicular block. IAIM, 2017; 4(11): 220-228. Page 221 December 2015 to May 2016 were included in the study. After obtaining written informed consent patients were divided into three groups of 30 in each group. Group A local anesthetics and perineural dexamethasone Group B local anesthetics & intravenous dexamethasone, Group C local anesthetics only. Results: The Sensory and Motor block onset time between the intervention groups group A VS group B and group A VS group C were found to be statistically significant (p < 0.05) and the association between group B VS group c was found to be not statistically significant (p>0.05) as per unpaired t-test. The sensory & motor block duration time showed statistical significance in group A VS group C, group B VS group C (p < 0.05) but group A VS group B had no statistical significance( p > 0.05) as per unpaired t-test. The association of Visual Analog Scale between the intervention groups (group A Vs group C and group B VS group C) and VAS scores at 6, 12 and 24 hours postoperatively were found to be statistically significant since p < 0.05 as per unpaired t-test. The number of doses of opioid required in 24 hours was considered to be statistically significant since p < 0.05 as per unpaired t-test between the intervention groups (group A VS group C and group B VS group C). Conclusion: Systemic Dexamethasone is equally effective as perineural Dexamethasone in providing the significant duration of sensory, motor blockade and quality of analgesia. We come to a conclusion that Dexamethasone consistently decreases the postoperative pain scores and decrease the early & number of doses of opioid consumption (48 hours).

Comparative study of bupivacaine alone and bupivacaine along with buprenorphine in axillary brachial plexus block: a prospective, randomized, single blind study.

Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomized single-blind study to compare Bupivacaine alone and Bupivacaine along with Buprenorphine for onset, quality, and duration of block as well as post-operative analgesia and any complication in axillary brachial- plexus block. Methods: Randomized controlled study was carried out among 60 patients of either sex, aged 20-60 years. ASA grade I or II undergoing elective hand, forearm, elbow surgery under axillary brachial plexus block. Patients were randomly divided into two groups. Group-l received 30 ml of 0.35% Bupivacaine alone in axillary block. Group-II received 30 ml of 0.35% Bupivacaine with 3µg/kg Buprenorphine in axillary block. Time taken for onset and completion of motor and sensory block as well as complete duration of block were noted in both groups. Any complication during procedure, during surgery as well as post-operatively were noted and treated. Results: Addition of Buprenorphine (3µg/kg) to Bupivacaine mixture in peripheral nerve block did not affected the onset time for motor as well as sensory block. Mean duration of motor block was 284.33±78.94 mins. in group I and in group II 307.33±60.26 mins. Mean duration of sensory block 305.066±83.64 mins. in group I while 580.166±111.45 mins. in group II. It suggests duration of sensory block was prolonged in group II then group I. Conclusions: Addition of Buprenorphine to local anesthetic drug provides good post-operative analgesia. Buprenorphine significantly prolongs sensory block and lengthens duration of analgesia without prolonging duration of motor block.

Clinical observation of different concentrations of ropivacayin combined with dezocine for Epidural analgesia / 中国综合临床

Objective To investigate the analgesic effect and motor block of ropivacayin combined dezocine in lower abodiminal operation.Methods Sixty patients of ASA Ⅰ - Ⅱ were divided into three groups randomly(n =20 for each group).They were treated with dezocine 5 mg +0.125％ ropivacayin/100 ml( group DI ),dezocine 5 mg +0.175％ ropivacayin/100 ml( group D2),dezocine 5 mg +0.225％ ropivacayin/100 ml (group D3 ).The initial dose was 5 ml,and the maintenance dose was 2 ml/h,with lock-out time of 20 mins,and the duration of patient-controlled epidermal analgesia (PCEA) was 48 h.The analgesic effect was evaluted by VAS score at 2,4,12,24 and 48 h after surgery.Bromage score and the side effects such as motor ability,and vomiting after surgery were recorded.Results At 2,4,12 h after surgery,the VAS scores of group D2 and D3 were less than that of group D1 (2.54 ± 1.34,2.47 ± 1.05 and 3.62 ± 1.02 at 2 hrs,2.13 ± 1.30,2.15 ± 1.28 and 3.56 ± 1.10 at 4 hrs,1.03 ± 0.43,1.04 ± 0.51 and 1.92 ± 1.20 at 12 hrs,respectively) ( Ps ＜ 0.05 ).As for the Bromage score among the 3 groups,there were no sighificant diffrences between group D1 and D2,wheras they were significantly lower than that in group D3 ( 1.21 ± 0.21,1.28 ±0.22 and 1.53 ± 0.31 at 2 hrs,1.15 ± 0.15,1.44 ± 0.25 and 1.61 ± 0.12 at 4 hrs,0.92 ± 0.14,0.99 ± 0.13 and 1.71 ± 0.22 at 12 hrs,0.85 ± 0.11,0.88±0.14 and (1.66±0.15) at 24 hrs,0.42 ± 0.10,0.55 ± 0.09 and 1.19±0.11 at 48 hrs,respectively,Ps ＜0.05).There were 2,2 and 3 patients affected with nausea and vomiting among the 3 groups,and there were no other side effects ( P ＞ 0.05 ).Conclusion 0.175％ ropivacayin combined with dezocine 5 mg via PCEA in lower abodiminal operation shows better analgesic effect and benefical to the restoration of lower limbs movements.

The potencies for motor block after intrathecal ropivacaine and bupivacaine / 中华麻醉学杂志

Objective To determine the median effective doae (ED50) for motor block after intrathecal ropivacaine and bupivacaine. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 18-64, weighing 46-75 kg, undergoing elective urological surgery under combined spinal-epidural anesthesia, were randomized into 2 groups ( n = 30each) receiving intrathecal 0.5% ropivacaine and 0.5% bupivacaine respectively. The ED50 was determined by up-down sequential allocation. The initial dose was 4 mg. Each time the dose increased/decreased by 1 mg. Efficacy was determined by the occurrence of any motor block in either lower extremity (modified Bromage scale > 0)within 5 or 10 min after the spinal injection. Results The intrathecal ED50 for motor block was 6.68 mg for ropivacaine (95% confidence interval 6.27-7.13 mg) and 4.07 mg for bupivacaine (95% confidence interval 3.56-4.47mg) . The relative motor blocking potency ratio was ropivacaine/bupivacaine 0.61. Conclusion The potency of intrathecal ropivacaine is lower than that of bupivacaine for motor block.

Regional intravenous anesthesia in knee arthroscopy

OBJECTIVE: The goal of the study was to investigate the regional intravenous anesthesia procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain. MATERIAL/METHOD: Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted.The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5 percent prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters. RESULTS: The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer. CONCLUSION: Regional intravenous anesthesia using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required.

Comparison of clinical effect of intrathecally administered fentanyl for elderly patients undergoing urologic surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.

Comparison of clinical effect of intrathecally administered fentanyl for elderly patients undergoing urologic surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.

Pressure sore after Cesarean section under epidural anesthesia and analgesia: Two cases report / 대한마취과학회지

Epidural anesthesia and analgesia provide a better outcome after major surgery. Several complications such as hypotension, motor block and dural puncture are well known. Epidural anesthesia and analgesia may also cause pressures sore in elderly and debilitated patients. Prolonged soft tissue compression results in discomfort and pain secondary to local ischemia in normal individuals. The presence of hypotension, hypothermia and the interruption of venous or lymphatic drainage of the lower extremities, as well as the lack of frequent repositioning, are all contributing factors to the development of pressure sore. We describe a pressure sore that occurred in two young and healthy parturients after epidural anesthesia and analgesia.

Effect of Normal Saline and Distilled Water Used for Dilution of 4% Plain Lidocaine in Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Lidocaine blocks sodium channels in nerve membranes, which inhibits sodium influx and prevents development of an action potential. For epidural anesthesia, we usually use lidocaine diluted in normal saline or distilled water. However, diluents containing sodium ions may affect lidocaine activity. METHODS: Fifty patients, ASA physical status class I or II, scheduled for elective epidural anesthesia were randomly divided into two groups.For epidural anesthesia, we used 14 ml of 2% lidocaine solution made with 7 ml of 4% lidocaine plus an equivalent of distilled water (Group DW) or normal saline (Group NS).In the right lateral decubitus position, a 19 G Arrow catheter was inserted 3 cm in the cephalad direction in the L3-4 intervertebral space.In the supine position, 3 ml of 2% lidocaine was injected as a test dose, and the remaining 11 ml of lidocaine was injected 2 minutes later.We used a pinprick test for evaluation of sensory block levels and a Bromage grade for degrees of motor block every 2 minutes during the first 30 minutes. RESULTS: Levels of sensory block were higher in Group DW than Group NS at 12, 14 and 30 minutes. The degree of motor block was also higher in Group DW at 12 and 14 minutes. CONCLUSIONS: Diluent containing sodium ions reduces sensory and motor block compared to sodium-free solution in epidural anesthesia.