[Using epidural anesthesia in patients with acute pancreatitis--prospective study of 121 patients].

According to a previous study, an excellent level of analgesia can be expected when using epidural anaesthesia in patients with acute pancreatitis. In the present investigation, the effectiveness and safety of epidural anaesthesia is demonstrated in a large group of patients with severe acute pancreatitis, who were admitted to an intensive care unit. Epidural anaesthesia alone produced excellent analgesia on 1,083 of 1,496 observation days (72%) without the systemic use of other analgesic substances.

[CSE vs. augmented epidural anesthesia for cesarean section. Spinal and epidural anesthesia with bupivacaine 0.5% "isobar" require augmentation].

Unlabelled: Incomplete anaesthesia is a major clinical problem both in single spinal and in single epidural anaesthesia. The clinical efficacy of epidural anaesthesia with augmentation (aEA) and combined epidural and spinal anesthesia (CSE) for cesarean section was investigated in a prospective randomized study on 45 patients.

Methods: Anaesthesia extending up to Th5 was aimed for.

[Local anesthetics--maximum recommended doses].

"Maximum doses" determined up to now do not take account of such important pharmacokinetic and toxicological data as: 1) the dependence of blood levels measured on the technique of regional anaesthesia, 2) and the raised toxicity of a local anaesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation differs according to the technique of local anaesthesia for A: subcutaneous injection, B: injection in regions of high absorption, C: single injection (perineural, e.g.

[Ropivacaine 1% versus bupivacaine 0.75% without a vasoconstrictor. A comparative study of epidural anesthesia in orthopedic surgery].

The long-acting local anaesthetic agent ropivacaine, S(-)-1-propyl-2',6'-pipecoloxylidid, is characterised by lower lipid solubility and lower cardiotoxicity compared with bupivacaine. This study was designed to evaluate its clinical efficacy and motor blocking properties when using lower volumes and higher concentrations of both plain substances. METHODS.

Prilocaine in lumbosacral plexus block--general efficacy and comparison of nerve stimulation amplitude.

The significance of the threshold amperage of peripheral nerve stimulation (PNS) for the efficacy and latency of sciatic block is shown in a controlled randomized study of stimulation amplitude. In all cases the block was complete within a short time when the threshold amperage was 0.3 mA or less.

Plasma prilocaine and mepivacaine concentrations after combined lumbosacral plexus block.

In a pharmacokinetic study of combined sciatic/3-in-1 block for lower limb surgery, the two moderate-acting local anaesthetics prilocaine and mepivacaine were compared. The mean maximum venous plasma concentrations of mepivacaine were more than twice as high as when prilocaine was used as anaesthetic (5.1 micrograms/ml vs.

[Epidural blockade for analgesia and treatment of acute pancreatitis].

The effect of a fractional epidural blockade on acute pancreatitis was investigated in a prospective study. PATIENTS AND METHODS. Thoracic (20 patients) or lumbar (six patients) epidural blockade was carried out in 26 patients with severe abdominal conditions comprising sub-ileus in 100%, pancreatic edema indicated by sonography/computer tomography in 57.

[Dose limits for local anesthetics. Recommendations based on toxicologic and pharmacokinetic data].

Since Heinrich Braun added adrenaline to cocaine (and later also to procaine) in 1903 to allow clinical use of this local anesthetic, "limiting dosages" for local anesthetics have been "recommended" with no reference to the technique of administration, on the assumption that adrenaline will lower the toxicity of the local anesthetic used. However, the limiting dosages determined up to now do not take account of important pharmacokinetic and toxicological data: (1) The dependence of blood levels measured on the technique of regional anesthesia and (2) the raised toxicity of a local anesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation that differs according to the technique of local anesthesia is suggested for (A) subcutaneous injection, (B) injection in regions of high absorption, (C) single injection (perineural, e.

[Can choice of medications and adjuvants reduce risks of local anesthetic complications?].

Local anesthetic agents in high concentrations may cause local irritation by ischemia especially after the use of adrenaline whereas felypressin has no tissue-irritating properties. Adrenaline but not felypressin increases the intravenous systemic toxicity. Noradrenaline has to be avoided as a vasoconstrictor.

[The function of peripheral nerve stimulators in the implementation of nerve and plexus blocks].

A selection of nine instruments supplied by eight different manufacturers for carrying out peripheral nerve stimulation were checked for their suitability, safety and ease of operation, and were compared and contrasted with reference to a spectrum of characteristics that appear desirable in theoretical and practical terms. Measurements at Ohm's resistance showed that in the clinically relevant range of impulse amplitudes (0.1-1.

[Fundamentals and requirements of peripheral electric nerve stimulation. A contribution to the improvement of safety standards in regional anesthesia].

The use of a nerve stimulator allows an injection cannula to be located without the cooperation of the patient. Regional anesthesia thus becomes safer because the basic condition "no paresthesia, no anesthesia" becomes irrelevant. In accordance with the basic electrophysiological conditions, a stimulator should have the following properties: (1) adjustable constant current at resistances of 0.

[Ropivacaine for peridural anesthesia. Studies on the dose-response relationship in orthopedic surgery].

In an open, nonrandomized dose response study, the efficacy of 0.75% ropivacaine (plain) for epidural analgesia was evaluated during 46 orthopedic surgical procedures (18 total hip replacements, 10 knee prostheses, 3 forefoot operations, 14 arthrotomies or osteotomies). Group 1 received 15 ml (112.

[Ropivacaine--a new local anesthetic with specific properties].

Ropivacaine is the (S)-enantiomer of 1-propyl-2',6'-pipecoloxylidide. In terms of its physicochemical properties, it is a long-acting local anesthetic (molecular weight of the base 274, pKa 8.07, protein-binding 92%).

[The single intercostal block--surgical and therapeutic indications].

Since the first paravertebral blockade was carried out by Sellheim in 1905, this method has proved effective for the isolated blockade of spinal nerves. The efficacy of preoperative intercostal blockade (ICB) in combination with neuroleptanalgesia (NLA) or Pentothal-pentazocine-N2O anesthesia (Pe-Pz) was studied (unilateral analgesia for cholecystectomy). Group 1: NLA; group 2: NLA with ICB; group 3: Pe-Pz; group 4: Pe-Pz with ICB.

[Influence of minimum current for peripheral nerve stimulation on the latency and success rate of sciatic blockade].

Unlabelled: The efficacy of conduction anesthesia depends to a great extent on accurate application of the local anesthetic solution (LA) in close proximity to the nerve trunk. The problem with most peripheral nerve stimulators available in the past was that they did not provide a small enough electrical stimulus. Correct positioning of the needle could not be guaranteed if muscle contractions occurred.

[Regional anesthesia in abdominal surgery].

Spinal and peridural anesthesia are most useful in lower abdominal operations. For upper laparotomies needing analgesia, good relaxation and quiet ventilation, intercostal block and peridural anesthesia with light general anesthesia are suitable techniques to avoid hypertension and metabolic responses (hyperglycemia, cortisol). During the postoperative period, regional blocks improve lung function and bowel motility, and afford early ambulation.