ABSTRACT
The mechanism of shivering during epidural analgesia remains unclear. This study investigates the role of the temperature of the local anaesthetic injected extradurally. Forty patients admitted for elective caesarean section under epidural anaesthesia were studied; 20 were given bupivacaine warmed to 37 degrees C (warm group) and 20 were given bupivacaine stored at 4 degrees C (cold group); the occurrence of shivering in both groups was recorded. The overall incidence of shivering was 27.5%; two patients of the warm group and nine patients of the cold group shivered. This difference was statistically significant (P less than 0.03). The results suggest that there are thermosensory mechanisms in the human spinal canal. In our view, epidural anaesthetic solutions should be warmed to body temperature prior to injection to reduce the incidence of shivering.
Subject(s)
Anesthesia, Epidural , Bupivacaine/adverse effects , Cesarean Section , Shivering , Adult , Female , Humans , Pregnancy , Spinal Canal/innervation , Temperature , Thermoreceptors/physiologyABSTRACT
To evaluate the width of the spinal canal when diagnosing spinal stenosis, 91 patients older than 59 years of age when undergoing myelography were studied. Using a sagittal diameter of 11 mm as border for the diagnosis of spinal stenosis, it was found that 31 of the 66 patients with spinal claudication, suspicion of spinal claudication and sciatic pain fulfilled this criterion and that 3/25 of the control group and those with atypic symptoms had a sagittal diameter of 11 mm or less. Five patients showed a complete block on the myelogram, and all of them had a typical spinal claudication. The spinal canal will narrow with age in asymptomatic patients as well, and the myelographic stenosis in elderly patients is not always equivalent to a clinical diagnosis of spinal stenosis.
Subject(s)
Myelography , Spinal Stenosis/diagnosis , Aged , Humans , Intermittent Claudication/etiology , Spinal Canal/innervation , Spinal Canal/pathology , Spinal Stenosis/complicationsSubject(s)
Brachial Plexus/anatomy & histology , Intercostal Nerves/anatomy & histology , Spinal Canal/innervation , Thoracic Nerves/anatomy & histology , Thoracic Vertebrae/innervation , Adolescent , Adult , Age Factors , Aged , Anthropometry , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Sex FactorsABSTRACT
In a group of 300 patients with the diagnosis of lumbar nucleus pulposus prolapse treated surgically the authors found in 4 cases not the expected prolapse but varicose blood vessels surrounding the nerve roots and immobilizing them in adhesions. In another 5 patients vertebral canal varicosities were associated with nucleus pulposus prolapse. None of these cases of vertebral canal varicosities had been diagnosed before operation since the clinical state of these patients was not significantly different from the state of patients with nucleus prolapse and radiculography failed to supply sufficient diagnostic data or suggested presence of small prolapse. An auxiliary diagnostic finding in cases of vertebral canal varices may be frequent association of spinal anomalies (in 3/4 of the observed cases) and obesity (in 2/3 of cases). Surgical decompression of vertebral canal and liberation of roots from adhesions without excision or ligation of varicose veins gave good therapeutic results.
