THE EFFECT OF pH ADJUSTMENT OF BUPIVACAINE ON EPIDURAL ANESTHESIA FOR CESAREAN SECTION

Douglas, M. Joanne; McMorland, G. H.; Jeffery, Wayne K.; Kim, J. H. K.; Ross, P. L. E.; Gambling, David R.; Swenerton, J. D.; Axelson, James E.

doi:10.1097/00000542-198609001-00379

Cited by 11 publications

(2 citation statements)

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“…pinprick, electrical stimulation, loss of temperature sense). Further clarification is required, but while the results with lignocaine appear convincing, those with bupivacaine were statistically significant, rather than clinically dramatic, in the series reported by Douglas and colleagues [24], in which the average time to peak effect was reduced from 25 to 18 min.…”

Section: Alkalinization (Ph Adjustment)mentioning

confidence: 92%

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Extradural, Spinal or Combined Block for Obstetric Surgical Anaesthesia

Carrie

1990

British Journal of Anaesthesia

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One of the outstanding features of obstetric surgical procedures carried out under regional anaesthesia is that the patients are seldom given premedication, peroperative sedation or light general anaesthesia which might mask any deficiencies in the local anaesthetic block. Before delivery this is in the interests of the fetus, which may be affected by any drugs given to the mother. For procedures carried out after delivery, sedation or anaesthesia interferes with the mother's enjoyment of her new baby, and may even jeopardize her safety if her respiratory protective reflexes are depressed. This is in contrast with other branches of anaesthesia in which regional techniques are popular-especially orthopaedics, where supplementary sedation or anaesthesia is commonplace. It is in obstetric anaesthesia, therefore, that the differences between extradural and spinal block may be most apparent, and in choosing between them it is necessary that the anaesthetist understands the relative merits of the two techniques. In accordance with popular usage, "anaesthesia" is used in this article, rather than "analgesia", although much of the time only freedom from pain is implied. In addition, " subarachnoid" and " intrathecal" are used synonymously with "spinal". FACTORS AFFECTING THE CHOICE BETWEEN EXTRADURAL AND SPINAL ANAESTHESIA General factors affecting the choice between extradural and spinal anaesthesia always include the expertise of the anaesthetist and the availability of suitable drugs and equipment. Historically, spinal anaesthesia antedated extradural KEY WORDS Anaesthesia, obstetric. Anaesthetic techniques: extradural. spinal.

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Section: Alkalinization (Ph Adjustment)mentioning

confidence: 92%

“…Significant reductions in onset time have been claimed for extradural mepivacaine [28], lignocaine [22], bupivacaine [24] and chloroprocaine [64,75]. All investigators do not agree with these findings, however, especially with respect to bupivacaine [76].…”

Section: Alkalinization (Ph Adjustment)mentioning

confidence: 98%

Extradural, Spinal or Combined Block for Obstetric Surgical Anaesthesia

Carrie

1990

British Journal of Anaesthesia

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Quantitative sensory examination of epidural anaesthesia and analgesia in man: combination of morphine and bupivacaine

Brennum

Petersen

Horn

et al. 1994

Pain

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The effect of epidural administration of a combination of low-dose morphine (2 mg) and bupivacaine (25 mg) on somatosensory and motor functions was examined in 13 healthy volunteers. The study design was a double-blind 4-way cross-over in which combined treatment was compared with either drug used alone or placebo. Every 2nd hour for 10 h effects on nociceptive and non-nociceptive somatosensory functions were quantified with 12 psychophysical measures. In addition knee extension strength, reaction time and skin temperature were examined. Epidural bupivacaine had hypoalgesic effect in all nociceptive tests, whereas epidural morphine only demonstrated hypoalgesic properties in nociceptive test with prolonged stimuli. In comparison with bupivacaine alone the combination treatment had a lesser peak effect but a more prolonged hypoalgesic action. In comparison with morphine alone the combination treatment induced a faster onset and demonstrated a modest increase in hypoalgesic effect in a subset of the test, even beyond the duration of bupivacaine when administered alone. Motor function was not attenuated by any of the treatments. Mechanisms of interaction between morphine and bupivacaine as well as their possible clinical implications are discussed.

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