RESUMO
Postpartum back pain may occur in up to 44% of women after childbirth. The increasing use of epidural analgesia during labour over the past 35 years has led many women and some doctors to attribute postpartum back pain to this. Such suggestions, if unfounded, may undermine parturients' confidence in epidural analgesia. However, the outcome of recent, randomized studies clearly shows that epidural analgesia does not cause back pain.
Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Dor nas Costas/induzido quimicamente , Transtornos Puerperais/induzido quimicamente , Feminino , Humanos , Incidência , Fatores de RiscoRESUMO
The comparative efficacy of two solutions of bupivacaine, 0.5% plain (isobaric-specific gravity 1.010), and 0.4% bupivacaine (hyperbaric-specific gravity 1.027) in 4% dextrose, for spinal anaesthesia was studied in 67 patients. Both solutions were clinically satisfactory (94% completely successful neural blockade). Hyperbaric bupivacaine blocks a greater number of spinal segments (p less than 0.01), causes a more rapid fall in blood pressure (p less than 0.05), and is more predictable in effect with regard to the number of segments blocked and to the lateralisation of the block. The duration of perioperative analgesia with the hyperbaric preparation is, however, shorter-3.8 hours as opposed to 5.8 hours (p less than 0.01)--but this was likely to be due to the smaller total dosage of bupivacaine used in the hyperbaric group. It is concluded that either solution may be used satisfactorily in clinical practice. The isobaric solution, however, despite its ready availability, is less satisfactory than the hyperbaric because its effect with regard to the extent of blockade is less predictable.
Assuntos
Raquianestesia/métodos , Bupivacaína , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade Específica , Espaço Subaracnóideo , Procedimentos Cirúrgicos OperatóriosRESUMO
In a prospective randomized trial, epidural buprenorphine was compared with intramuscular morphine for pain relief after spinal corrective surgery. Both forms of analgesia were given on demand and both produced excellent reduction of pain as assessed with visual linear analogue. The quality and duration of analgesia were similar for both groups of patients. Since the correct placement of epidural catheters could be done intraoperatively in difficult cases and since many patients for spinal corrective surgery have limited respiratory reserve, the authors feel that epidural buprenorphine provides an excellent alternative to conventional opiate analgesia after this type of surgery.
Assuntos
Buprenorfina/uso terapêutico , Morfinanos/uso terapêutico , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Fusão Vertebral , Adulto , Buprenorfina/administração & dosagem , Espaço Epidural , Feminino , Humanos , Injeções , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Estudos Prospectivos , Distribuição AleatóriaRESUMO
Fifteen millilitre of 2.5% thiopentone was accidentally injected via the axillary route to the brachial plexus sheath of a fit 17-yr-old male. Mild discomfort was experienced during the injection. Immediate treatment included injection of normal saline 40 ml and 1% lignocaine with adrenaline (1 : 200,000) 40 ml to the sheath. A stellate ganglion block was also performed and dexamethasone administered i.v. The patient experienced moderate local pain and tenderness during the subsequent 3 days, but no neurological or vascular sequelae. Guidelines for the prevention and treatment of this mishap are suggested.
