Axillary brachial plexus block with ropivacaine 7.5 mg/ml. A comparative study with bupivacaine 5 mg/ml.

BACKGROUND: Ropivacaine is less cardiotoxic than bupivacaine and may be used in higher doses in order to increase the quality of a block. The aim of this study was to compare the efficacy and safety of 40 ml ropivacaine 7.5 mg/ml (300 mg) and 40 ml bupivacaine 5 mg/ml (200 mg) for axillary plexus block. METHODS: One hundred and four adult patients were included in a prospective, double-blind study. Sensory and motor block were tested for the five main terminal nerves of the arm at 10-min intervals until start of surgery and every second hour there-after until full resolution of the block. RESULTS: The overall evaluation of the block by the surgeon and the anesthesiologist showed a significantly better quality in the ropivacaine patients, regarding both anesthesia and motor block. There were no differences in the time to onset and duration of the block. Except for one patient, who had seizures after an accidental IV injection of ropivacaine, there were no major side effects. CONCLUSION: Ropivacaine 7.5 mg/ml, 40 ml, produces axillary plexus block of similar onset and duration but better quality than 40 ml of bupivacaine 5.0 mg/ml.

["Gentlemen, this is not a humbug". The 150th anniversary of anesthesia]. / "Mine herrer, dette er ikke humbug". Anestesien er 150 år.

On 16 October 1996 it was 150 years since William T.G. Morton performed the first successful demonstration of ether anaesthesia in the Massachusetts General Hospital, Boston, USA. Controlling the pain caused by surgery had been a problem for a long time. In fact, many chemical agents with pain relieving properties were recognized before they were used in practice. Morton started systematic studies on the anaesthetic effects of ether and convinced the medical world of the importance of pain free operations through his demonstration of ether inhalation. The news about ether anaesthesia spread around the world very quickly. The first ether anaesthesia administered in Norway took place at Rigshospitalet in Christiania on 4 March 1847. The first death from anaesthesia in Norway occurred in 1852. This article presents some aspects of both the Norwegian and international history of anaesthesia.

Statistical aspects in studies of preoperative fluid intake and gastric content.

Twelve randomised studies of preoperative intake of clear fluids and gastric content were reviewed and presented together with a separate study performed by the authors. A common deficiency in design was the omission of detailed information concerning randomisation procedures, distribution of data, and choice of statistical methods. Only one reviewed study included power calculations and only 3 reported 95% C.I. (Confidence Intervals). Deficiencies in design and data collection rendered the conclusion of two studies invalid. Incorrect use of statistical tests in some of the remaining studies may have resulted in non-significant differences becoming statistically significant. This, however, did not change the main conclusion of a meta-analysis that intake of clear fluids up to 2 hours before general anaesthesia was safe as fluid intake either decreased or had no effect on gastric fluid volume.

[Dilemmas in sports medicine--a medical challenge]. / Idrettsmedisinske dilemmaer--en medisinsk utfordring!

The theme of the article is ethical problems and dilemmas in sports medicine. Our practice should be guided by medical norms and rules and the fair play-norm of sport. International and national examples are presented and used to elucidate some dilemmas. A special problem for the doctor may be loyalty to the team and to the coach. Use of drugs can be a temptation for doctor as well as for athlete. Misuse of athletes as experimental subjects has been a problem in some countries.

Comparison of 40 milliliters of 0.25% intrapleural bupivacaine with epinephrine with 20 milliliters of 0.5% intrapleural bupivacaine with epinephrine after cholecystectomy.

To determine the influence of the volume of local anesthetic injected for intrapleural analgesia, 40 patients undergoing cholecystectomy were randomly allocated to two groups of 20 patients each. One group received 40 mL of 0.25% bupivacaine with epinephrine injected intrapleurally postoperatively. The other group received 20 mL of 0.5% bupivacaine with epinephrine. The onset time of analgesia was nearly the same in both groups and within 25 min all patients were nearly pain free. Our data demonstrate that 100 mg of bupivacaine with epinephrine elicits effective analgesia after cholecystectomy. There are only minor differences between 20 and 40 mL with regard to pain relief. The authors conclude that the volume of local anesthetic within the range of 20-40 mL in an adult has little influence on the extent or duration of intrapleural analgesia.

Distribution of bupivacaine after interpleural injection in rats.

The absorption and distribution of bupivacaine in several tissues was studied after interpleural injection of 14C-labelled bupivacaine through a small needle interpleurally on the right side in male rats. 14C-labelled bupivacaine 10 microCi/mmol was injected at a dose of 2.5 mg/kg. The animals, a total of 42, six at each testing time, were sacrificed at 5, 10, 20, 30, 60, 120 and 180 minutes after the interpleural injection. Bupivacaine concentration was then determined on the basis of the amount of radioactivity in tissues taken from 23 different locations. The highest concentration of bupivacaine, about 40 pmol/micrograms tissue, was found in the right lung in the middle and inferior lobes. In the inferior and dorsal aspects of the right thoracic wall, the concentrations were in the same range. In the more peripheral organs, such as the musculature in the legs, the concentration was as low as less than 5 pmol/micrograms. In the central nervous system, the concentration was less than 10 pmol/micrograms. Our conclusion is that interpleurally administered bupivacaine remains in the area of injection for a considerable time.

Side effects and complications related to interpleural analgesia: an update.

Interpleural analgesia has been successfully used for pain relief after cholecystectomy, renal surgery, breast surgery and thoracotomy. Little has been reported about side effects and complications. This article summarizes available information about adverse events collected from the literature. The survey comprises a total of 703 cases. Pneumothorax was the most frequently registered complication followed by signs of systemic toxicity and pleural effusion. Horner's syndrome, pleural infections and catheter rupture have also been reported.

Hemodynamic effects of interpleural analgesia in pigs.

Six anesthetized pigs received bupivacaine 2 mg/kg with epinephrine 2 micrograms/kg interpleurally while six saline injected animals served as controls. The animals were monitored hemodynamically for 120 min after injection. There were no significant changes in hemodynamic variables in the control group. In the group receiving bupivacaine with epihephrine there was a pattern of increase in mean arterial blood pressure, systemic vascular resistance and mean pulmonary arterial blood pressure after 60 min of observation. There were no other significant changes in pulmonary or systemic hemodynamics or gas exchange as evaluated by blood gases or whole body oxygen consumption. It is speculated that the increased systemic vascular resistance was an effect of the epinephrine added to the anesthetic. Interpleural analgesia may be a safe pain-relieving method even in slightly hypovolemic individuals.

Distribution of local anesthetics injected into the interpleural space, studied by computerized tomography.

Twenty-one patients were given interpleural analgesia for postoperative pain relief after cholecystectomy, or renal or breast surgery. The patients were classified randomly into two groups: an interpleural injection of 20 ml of 0.375% bupivacaine mixed with 10 ml contrast medium was given to 11 patients in the supine position, and 10 in the lateral position. The patients remained in this position for 1 h. There was no significant difference in the rostrocaudal distribution of the contrast on computerized tomography taken 20 min later: Th3-L1 in the supine group vs. Th5-L1 in the lateral group. In the supine group the mean level of contrast medium reached significantly higher medially along the mediastinum (51 +/- 11 mm) than laterally (27 +/- 11 mm).

[Morten Parelius. A polyhistorian and an occasional poet, but above all a physician]. / Morten Parelius. Polyhistor og leilighetsdikter, men først og fremst lege.

Parelius worked as local medical officer in the western parts of Norway. He wrote poems and medical articles, most of which were published in journals. This article is a biography.

[The rescue action in Trollveggen during the Easter holiday in 1989. General and medical experiences]. / Redningsaksjonen i Trollveggen påsken 1989. Generelle og medisinske erfaringer.

In the spring of 1989, an English climber had an accident on Trollveggen in Romsdalen. This article describes the rescue operation. This article also includes the history of Trollveggen, and generally discusses the planning and strategy of such rescue operations.

Intrapleural administration of 0.25%, 0.375%, and 0.5% bupivacaine with epinephrine after cholecystectomy.

Thirty patients who had undergone cholecystectomy (subcostal incision) were randomly allocated to three groups of ten patients each and given intrapleural injections of 20 ml 0.25% (group I), 0.375% (group II), or 0.5% (group III) bupivacaine each with added epinephrine (5 micrograms/ml). Complete pain relief was obtained within 30 minutes in all but one patient in groups I and II. Pain scores (VAS, 0-100 mm) were recorded at regular intervals and did not exceed 20 mm (mean) in any group from 30 minutes up to 4 hours. Median time interval from the intrapleural injection to administration of supplementary analgesics was 4 hours 20 minutes, 6 hours, and 7 hours 45 minutes in groups I, II, and III, respectively. The maximum plasma concentration of bupivacaine (Cmax), 0.62 (+/- 0.25 SD) microgram/ml in group I, 0.82 (+/- 0.40) microgram/ml in group II, and 1.20 (+/- 0.44) microgram/ml in group III, was significantly higher in group III than in the other groups. The time to achieve maximum plasma concentration of bupivacaine (Tmax) was approximately 15 minutes in all groups. No side effects were observed.