ABSTRACT
We have prospectively assessed pain and anxiety of spinal puncture in 180 adult patients randomly allocated to one of three equal groups. On the morning of surgery group 1 had an EMLA patch, whereas group 2 and 3 had placebo patches. Group 2 also had infiltration analgesia with 2 ml lignocaine 2% with adrenaline, immediately before the block. Spinal anaesthesia was performed with 25 gauge sharp needles without introducer or 25,27 gauge blunt needles with 20,22 gauge introducers. Patients assessed the spinal puncture pain on a 10-cm visual analogue scale immediately after removal of the needle. Pain scores were significantly lower in group 1 (EMLA), median 0.75, than in group 2 (placebo, infiltration analgesia), median 1.75, and group 3 (placebo), median 1.80, p < 0.0001. Pain intensity was less than expected in more patients in the EMLA group than in the other two groups, p = 0.034. However, the decision to accept/reject spinal anaesthesia in the future was not influenced by the pain of lumbar puncture. We conclude that application of an EMLA patch is a simple and effective method to provide adequate analgesia for spinal puncture, which also helps to allay patients' fears of spinal anaesthesia.
Subject(s)
Anesthesia, Spinal/adverse effects , Anesthetics, Combined/therapeutic use , Anesthetics, Local/therapeutic use , Lidocaine/therapeutic use , Pain/prevention & control , Prilocaine/therapeutic use , Administration, Cutaneous , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Lidocaine, Prilocaine Drug Combination , Male , Middle Aged , Pain/etiology , Prospective Studies , Spinal Puncture/adverse effectsABSTRACT
Autonomic hyperreflexia is a serious complication for tetraplegic patients, especially during labour and delivery. The symptoms are piloerection, facial flushing, anxiety, headache, serious blood pressure crises and cerebrovascular accidents. A 30 year-old woman who was tetraplegic following a high cervical spinal cord lesion, showed signs of autonomic hyperreflexia. In early labour epidural analgesia was established and the vaginal delivery was successful without associated fluctuation of the blood pressure or other signs of autonomic hyperreflexia.
Subject(s)
Autonomic Nervous System/physiopathology , Obstetric Labor Complications/physiopathology , Quadriplegia/complications , Reflex, Abnormal , Adult , Female , Humans , PregnancyABSTRACT
A prospective registration was carried out of all injuries or near-injuries to hospital staff that took place while the staff were engaged in transporting patients between hospitals. A total of 480 transports were registered over one year. Of these, 146 took place as emergencies, 60 with police escort. Four accidents to staff were registered (0.86% of all transports), where the staff in two cases suffered light bruising. Equipment that is brought along in order to treat and monitor patients should be able to be securely fastened during transport with a view to optimizing safety during transportation for patients and staff.
