Perineural clonidine does not prolong levobupivacaine 0.5% after sciatic nerve block using the Labat approach in foot and ankle surgery.

Background: There is controversy about the effectiveness of perineural clonidine used as an adjuvant to local anesthetics. This study investigated whether the addition of 150 μg clonidine to 0.5% levobupivacaine used for posterior sciatic nerve block would prolong the duration of analgesia.

Levobupivacaine 0.5% provides longer analgesia after sciatic nerve block using the Labat approach than the same dose of ropivacaine in foot and ankle surgery.

Background: Levobupivacaine and ropivacaine are 2 left enantiomeric molecules frequently used for peripheral nerve blocks because of their safe clinical profile. Levobupivacaine is more lipophilic and theoretically more potent than ropivacaine, but clinical studies show conflicting results in terms of anesthetic and analgesic characteristics. We hypothesized that the pure S-enantiomer of bupivacaine provides longer-lasting analgesia than ropivacaine.

A new anatomical technique to investigate nerves by imagery.

Introduction: We describe a novel post mortem technique that makes it possible to visualise the nerve structure of the brachial plexus using imaging.

Materials And Methods: We dissected in situ the brachial plexus of a cadaver preserved by formaldehyde. A preparation composed of a mixture of baryte powder, water and colorant, was applied to all sides of the brachial plexus and blood vessels of the region under study.

No differences between 20, 30, or 40 mL ropivacaine 0.5% in continuous lateral popliteal sciatic-nerve block.

Background And Objectives: The aim of this study was to compare the anesthetic and analgesic characteristics of the administration of an initial bolus of 20, 30, or 40 mL of ropivacaine 0.5% through a lateral popliteal sciatic catheter.

Methods: Sixty patients scheduled for foot surgery under continuous sciatic lateral popliteal nerve block were included in this double-blinded study.

Partial sensory and motor deficit of ipsilateral lower limb after continuous interscalene brachial plexus block.

We describe a partial sensory and motor block of the ipsilateral lower limb after interscalene infusion. After and injection of 20 mL of ropivacaine through the needle, the catheter was advanced 5 cm, and an infusion of ropivacaine 0.2% 5 mL/h commenced.

Intrathecal sufentanil is more potent than intravenous for postoperative analgesia after total-hip replacement.

Background And Objectives: In our clinical experience, sufentanil is more effective when administered intrathecally than intravenously. To test this hypothesis, we compared the analgesic characteristics of 7.5 microg of intrathecal or intravenous sufentanil for pain relief after total-hip replacement.

Posterior labat vs. lateral popliteal sciatic block: posterior sciatic block has quicker onset and shorter duration of anaesthesia.

Background: During foot and ankle surgery, a combination of a sciatic and femoral nerve block is a well-recognized technique for providing anaesthesia and post-operative analgesia. Our hypothesis is that the posterior gluteal sciatic block (PSB) is more efficient than the lateral popliteal sciatic block (LPSB), and this study compared the anaesthetic characteristics between these two techniques performed for elective ankle and foot surgery.

Methods: This retrospective database analysis reviewed the onset, duration of action, success rate and complications among 287 patients who were operated upon using sciatic block.

Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter.

Purpose: This dose-response study was designed to determine the most appropriate dose of ropivacaine 0.5% injected via an indwelling femoral catheter for perioperative peripheral analgesia for total knee replacement (TKR).

Methods: 84 patients were allocated randomly to four groups and received, via a femoral catheter, either 15, 20, 25 or 30 mL of ropivacaine 0.

Skull base cerebrospinal fluid fistula: a novel detection method based on two-dimensional electrophoresis.

Background: The detection of the presence of cerebrospinal fluid (CSF) in nasal secretions contaminated with blood and mucus remains a challenging clinical problem.

Methods: A prospective study was conducted from November 1998 to February 2002, including 42 patients. Samples (250 microL) of nasal secretions were analyzed by two-dimensional electrophoresis (2-DE).

Isobaric versus hypobaric spinal bupivacaine for total hip arthroplasty in the lateral position.

Unlabelled: Total hip arthroplasty (THA) is frequently performed under spinal anesthesia using either isobaric or hypobaric anesthetic solution. However, these two solutions have never been compared under similar surgical conditions. In the present study, we compared the anesthetic and hemodynamic effects of isobaric and hypobaric bupivacaine in 40 ASA physical status I-II patients undergoing THA in the lateral decubitus position under spinal anesthesia.

Epinephrine and clonidine do not improve intrathecal sufentanil analgesia after total hip replacement.

Background: We compared analgesia after intrathecal sufentanil alone, sufentanil with epinephrine 200 microg and sufentanil with clonidine 30 microg in patients after total hip replacement, the endpoints being onset and duration of action.

Methods: We performed a randomized double-blind study of 45 patients for elective total hip arthroplasty using continuous spinal anaesthesia. As soon as a pain score higher than 3 on a 10 cm visual analogue scale was reported, sufentanil 7.

Cerebrospinal fluid density influences extent of plain bupivacaine spinal anesthesia.

Background: The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine.

Epinephrine does not prolong the analgesia of 20 mL ropivacaine 0.5% or 0.2% in a femoral three-in-one block.

Unlabelled: We tested the effect of epinephrine added to 20 mL ropivacaine 0.5% and 0.2% on postoperative analgesia via a femoral catheter after total knee replacement.

Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes.

Unlabelled: Clonidine in brachial plexus block prolongs analgesia of local anesthetics of short and intermediate duration. We performed a prospective randomized double-blinded study to determine the efficacy and adverse effects of clonidine mixed with a long-acting local anesthetic on postoperative analgesia. Sixty adult patients underwent elective rotator cuff repair using interscalene brachial plexus block combined with general anesthesia and were randomly divided into one of the following three groups.

Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement.

Background: We designed this study to compare the postoperative analgesic effects of intrathecal morphine and nalbuphine, the endpoints being onset and offset of action.

Methods: Geriatric patients scheduled for elective total hip replacement under continuous spinal anaesthesia were randomized to two double-blinded groups in the recovery room as soon as they experienced a pain score higher than 3 cm on the visual analogue scale (VAS, 0-10 cm). Either 160 microg morphine or 400 microg nalbuphine in 4 ml normal saline were administered intrathecally.

Extent of hyperbaric spinal anesthesia influences the duration of spinal block.

Background: The influence of spread of spinal anesthesia on the duration of spinal blockade has been suggested but never investigated specifically. Because elimination of local anesthetic from subarachnoid space is probably dependent of the surface available for its diffusion and vascular absorption, the current study was designed to evaluate the hypothesis that with a same dose of hyperbaric bupivacaine, a higher anesthetic level would result in a shorter duration of spinal blockade than a lower level.

Methods: Three milliliters (15 mg) of hyperbaric bupivacaine, 0.

Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty.

Background: The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure.

Methods: In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block.

A comparison of intrathecal analgesia with fentanyl or sufentanil after total hip replacement.

Unlabelled: We designed this study to compare the postoperative analgesic effects of intrathecal fentanyl and sufentanil, the end points being onset, quality, and duration of action. A total of 42 geriatric patients, scheduled for elective total hip replacement under continuous spinal anesthesia, were randomized in two double-blinded groups as soon as they experienced a pain score higher than 3 of 10 on the visual analog scale in the recovery room. Either 7.

Influence of sex on cerebrospinal fluid density in adults.

The extent of sensory block during spinal anaesthesia is unpredictable and is influenced by many factors, mainly patient position, site of injection, baricity and the dose of drug injected. Among other factors, cerebrospinal fluid (CSF) density has been advocated to affect subarachnoid distribution of local anaesthetics. In this study, we have investigated the influence of patient characteristics such as sex, age, weight and height on variations in the density of CSF in more than 46 consecutive patients undergoing spinal anaesthesia.

Efficacy of three test doses to detect epidural catheter misplacement.

Purpose: To determine among three currently used epidural test doses which is the most reliable for the detection of accidental intrathecal misplacement of an epidural catheter, and which clinical sign is to be used as a marker.

Methods: Ninety orthopedic patients were allocated to either the continuous epidural or the continuous spinal group according to age, < or > 70 yr. They received, in a randomized, double-blind fashion, one of the three solutions: 60 mg lidocaine 2% (L2%), 7.

[Effect of administration of recombinant human erythropoietin in acute normovolemic hemodilution on transfusion needs during total hip prosthesis implantation].

Acute normovolaemic haemodilution (ANH) is used to avoid perioperative blood loss and consists of the withdrawal of whole blood just before or just after anaesthesia induction and its simultaneous replacement by synthetic colloids and crystalloid solutions. In an attempt to improve the efficiency of this technique while at the same time avoiding cardiovascular complications, we set up a pilot study to test the association of rHuEpo/ANH during elective surgery for total hip replacement. Five patients (3 males, 2 females) were included in this study.