OBJECTIVES To compare the efficacy of continuous extrapleural intercostal nerve block with bupivacaine 0.5% in 1:200,000 epinephrine and continuous lumbar epidural block with morphine in controlling post-thoracotomy pain and to measure serum bupivacaine concentrations during extrapleural infusion. DESIGN A prospective, randomized, controlled trial. SETTING St. Joseph's Hospital, Hamilton, O...

BACKGROUND AND OBJECTIVES Most studies in the literature correlating epidural opioids to postoperative shivering were carried out with obstetric patients whose thermoregulation center response might be different from non-pregnant patients. Our study aimed at comparing intra and postoperative shivering and other complications of epidural block with and without fentanyl in patients submitted to v...

To the Editor: The insertion of an epidural for pain relief in labour was complicated by a dural puncture. During the subsequent infusion the patient complained of numbness over her face. There was no accompanying tinnitus or circumoral numbness and pulse and blood pressure remained within normal limits. On examination an area of numbness, to pain and cold, was confined to the bilateral distrib...

BACKGROUND The initial treatment of an acute blood loss with acellular fluids leads to the dilution of the red cell mass remaining in the vasculature, that is, to acute normovolemic anemia. Whether the compensation and, thus, the tolerance of acute anemia, are affected by sympathetic block induced by thoracic epidural anesthesia has not yet been investigated. METHODS Eighteen anesthetized and...

SUMMARY A brief outline of the history of epidural analgesia is followed by a review of the anatomy of the epidural space with particular reference to epidural block. The technique of epidural injection in the dog is described as are the indications for the technique. These include the provision of anaesthesia for such procedures as orthopaedic surgery of the hind limb and caesarian section. Th...

Background: Epidural block provides surgical anesthesia as well as post-operative analgesia in patients undergoing lower abdominal surgeries. Ropivacaine, is safe and effective for regional anesthetic techniques. Dexmedetomidine, alpha-2 agonist, as adjuvant to local anesthetic is reported to have synergistic effect for epidural anesthesia. The present study was designed with the aim to evaluat...

The effectiveness of neuraxial blockade remains a very debatable issue. Many orthopaedic surgical procedures can be performed using either a single spinal shot, an epidural catheter neuraxial blockade, or general anesthesia. Memtsoudis (2013) reviewed nearly 400.000 patients undergoing primary hip or knee arthroplasties compared neuraxial versus general anesthesia, and reported that the 30-day ...

Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological dis...

Morbidity after paediatric epidural anaesthesia is unusual. We report a case of transient motor nerve root block in an eleven years old girl receiving epidural analgesia postoperatively following anterior instrumented spinal fusion for scoliosis. The epidural catheter was placed within the T8-T9 inter-space under general anaesthesia. Postoperatively the child developed unilateral paradoxical ch...

Ketamine has been shown to have analgesic effect by blocking N-methyl-D-aspartate receptor, thus preventing and reducing central sensitization caused by peripheral nociceptive stimulation. However, due to lack of knowledge about its safety and toxicity in the central nervous system, either epidural or intrathecal injection of ketamine still remains controversial. Here, we describe a case report...