Document Detail


Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine.
MedLine Citation:
PMID:  16368841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the T7-8 or T8-9 intervertebral space into 2 groups. The control group (n = 10) received an epidural test dose of 4 mL lidocaine 2% during spontaneous breathing at ambient pressure. The continuous positive airway pressure (n = 10) group received the same epidural test dose but during spontaneous respiration with 7.5 cm H2O continuous positive airway pressure. The groups were comparable with respect to demographic variables. Fifteen minutes after the conclusion of the epidural injection, the sensory block ranged from from T4 [median, interquartile range 2.75 segments] to T11 (interquartile range 3.5 segments) in the control group and from T5 (interquartile range 2.25 segments) to L2 (IQR 2.25 segments) in the continuous positive airway pressure group (P = 0.005 for the caudal border). The total number of segments blocked was 7 (median, interquartile range 2.25) in the control group and 11 (interquartile range 3.5) in the continuous positive airway pressure group (P = 0.004). The number of segments blocked caudad to the injection site was 3 (median, interquartile range 3.5) in the control group and 6 (interquartile range 2.25) in the continuous positive airway pressure group (P = 0.005). We conclude that continuous positive airway pressure increases the spread of sensory blockade in thoracic epidural anesthesia, primarily by a more caudad extension of sensory blockade.
Authors:
W Anton Visser; Mathieu J M Gielen; Janneke L P Giele
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  102     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-21     Completed Date:  2006-01-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  268-71     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, Breda, The Netherlands. avisser@amphia.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Continuous Positive Airway Pressure / methods*
Double-Blind Method
Female
Humans
Injections, Epidural
Lidocaine / administration & dosage*
Male
Middle Aged
Nerve Block / methods*
Neurons, Afferent / drug effects*,  physiology
Respiration / drug effects*
Thoracic Vertebrae / drug effects,  physiology
Chemical
Reg. No./Substance:
137-58-6/Lidocaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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