Spread of Analgesic Solutions in the Epidural Space and Their Site of Action: A Statistical Study

Bromage, Philip R.

doi:10.1093/bja/34.3.161

Cited by 174 publications

(88 citation statements)

References 12 publications

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“…This block does not occur in a haphazard fashion, but rather in an orderly and sequential manner depending on fibre size and myelination. [12][13][14][15][16][17][18][19][20] Proprioception, soma tic motor sense BETA [5][6][7][8][9][10][11][12] Pressure GAMMA [3][4][5][6] Motor to muscle spindle post-ganglionic sYmEathetic Adapted from GANONG (42 ) 6.…”

Section: Chapter II Physiological and Pharmacological Considerationsmentioning

confidence: 99%

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

Wahba¹,

Craig²,

Don³

et al. 1973

Survey of Anesthesiology

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The cardio-respiratory effects of a thoracic epidural anaesthetic as is given for pain relief following upper abdominal surgery were examined in thirteen surgical patients studied in the immediate pre-operative period.following an overnight fast and without premedication.The focus of interest was on its effects on FRC and on gas exchange (measured as A-aD02 and OS/OT%), waich have not been previously reported. AlI subjects were given 10 ml/Kg glucose in saline I.V. during the pre-epidural periode Lidocaine 1.5% was used in aIl cases, plain lidocaine for the first eight and lidocaine with epinephrine 1/200,.000 in the other five subjects. This agent was given to achieve a sensory block to both pin-prick and ice up to T4. Neither FRC nor gas exchange showed any consistent changes following the epidural anaesthetic. These findings are in keeping with what was anticipated from a consideration of the basic physiology and pharmacology concerned and with a review of the pertinent literature. following an overnight fast and without premedication.The focus of interest was on its effects on FRC and on gas exChange (measured as A-aD02 and OS/OT%), which have not been previously reported. All subjects were given 10 ml/Kg glucose in saline I.V. during the ~re-epidural periode Lidocaine 1.5%was used in all cases, plain lidocaine for the first eight and lidocaine with epinephrine 1/200~OOO in the other five subjects. This agent was given to achieve a sensory block to both pin-prick and ice up to T4. Neither FRC nor gas exchange showed any consistent Changes following the epidural anaesthetic. These findings are in keeping with what was anticipated from a consideration of the basic physiology and pharmacology concerned and with a rev~ew of the pertinentliterature.w. MELEIKA~WAHBA' M.Sc. Exp. Red.

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Section: Chapter II Physiological and Pharmacological Considerationsmentioning

confidence: 99%

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

Wahba¹,

Craig²,

Don³

et al. 1973

Survey of Anesthesiology

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“…12 The extent of the resulting block in this case from C4-5 caudally, suggests that bilateral block of the lateral spinal tracts had occurred.…”

Section: Coblenzmentioning

confidence: 69%

An unusual complication after stellate ganglion block by the paratracheal approach: A case report

Forrest

1976

Canad. Anaesth. Soc. J.

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Tlax VA~TaACHEAL AVPROACH for blockade of the stellate ganglion has been recommended as the safest route 1 because of its technical simplicity and lack of complications e when low doses of local anaesthetic solutions are used. Subarachnoid block associated with infiltration of the stellate ganglion has been cited as a rare complication. 1,a-9 The evidence from the literature would suggest that the commonest cause of subarachnoid block is accidental dural puncture either by directly entering the spinal canal, particularly when the lateral or anterolateral route is employed ~ or through an abnormal dural extension through the intervertebral foramena such as cervical meningocele. 1~The case of inadvertent subarachnoid block described by Magora 6 and discussed by Moore r where the paratracheal approach was used would seem to have resulted from penetration of the subarachnoid space caused by sudden movement by the patient during injection.The use of repeated injections of the stellate ganglion in the management of intractable pain of the sympathetic dystrophic types has gained popularity during the last three decades because of the high rate of long-term remission. Serial blocks are thought to disorganize the reflex activity which is triggered in the internunceal neuronal pool of the spinal cord as well as in the sympathetics themselves. 2The following case is presented to emphasize a possible hazard of repeat stellate ganglion block by the paratracheal route. CASE REPORTA 54-year-old woman was referred to the Pain Clinic for the management of left upper limb Raynaud's phenomena complicating long-standing diabetes mellitus. A diagnosis of bilateral carpal tunnel syndrome had been made about 18 months previously and was associated with marked median nerve sensory loss with paraesthesia particularly on the left side. Left carpal tunnel decompression was performed under I.V. regional block with 1.5 per cent lidocaine, but did little to relieve her symptoms. Indeed, during the months after surgery the pain was much worse, being aggravated by cold, emotion and exercise. When she was first seen at the clinic, she had moderately severe loss of motor function of the left hand and virtually continuous pain; the left hand was also cold and pale, indicating moderate ischaemia.The patient was a fairly heavy smoker (more than 20 cigarettes per day) and

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“…Pain thresholds are higher in men than women [1,[16][17][18][19], and the median effective anaesthetic dose of caudal ropivacaine is less for men (0.296%) than women (0.389%) [2]. The neuraxial distribution and clinical effects of local anaesthetics are influenced by dose, volume, concentration and potency, as well as a patient's age, height, posture, pregnancy status and atherosclerosis [3,[20][21][22][23][24][25][26][27][28][29][30]. However, weight, height and BMI do not influence the extent of sensory analgesia after the subarachnoid injection of bupivacaine [26,27].…”

Section: Discussionmentioning

confidence: 99%

Strength and sensation after epidural ropivacaine in men and women

et al. 2015

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SummaryWe injected 15 ml epidural ropivacaine in 30 men and 30 women to determine the median dose required to impair a straight-leg raise. We started at a concentration of 0.425%, increasing the concentration by 0.025% after an ineffective injection and decreasing the concentration by 0.025% after an effective injection. The median (95% CI) concentration of ropivacaine that prevented straight-leg raise within 30 min of injection was 0.43% (0.41-0.45%) in men and 0.40% (0.39-0.41%) in women, p = 0.001. There were no differences in dermatome levels for loss of pinprick and cold sensation between men and women.

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Spread of Analgesic Solutions in the Epidural Space and Their Site of Action: A Statistical Study

Abstract: Relationship) of height and segmental dose for 2 per cent solutions in 155 normal patients between the ages of 20 and 81 years (supine position).

Cited by 174 publications

References 12 publications

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

An unusual complication after stellate ganglion block by the paratracheal approach: A case report

Strength and sensation after epidural ropivacaine in men and women

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