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B Lisander

Publications and source records attributed to B Lisander.

79 records · Page 5Linked to original sources
PubMedDate not supplied

Quantitative sensory changes in humans after intravenous regional block with mepivacaine.

BACKGROUND AND OBJECTIVES: In previous studies we have demonstrated that after intravenous regional block (IVRA) with dilute mepivacaine, there is a decrease in neurogenic inflammation as well as in post-ischemic hyperemia and steady-state flow, the latter for at least 60 minutes. It is unclear whether these vascular reactions reflect a uniform depression of nerve function in the treated arms. Because the various afferents convey impulses from different types of sensory receptors, we used quantitative sensory testing (QST) to define these effects of IVRA with mepivacaine. METHODS: In 16 volunteers, bilateral blocks were performed by simultaneously injecting mepivacaine in one arm and normal saline in the other in a randomized, double-blind manner. Both arms were kept ischemic for 20 minutes, and the pain was rated on a visual analogue scale. Skin temperature and perception threshold values regarding touch (Abeta-fibers), warmth (C-fibers) and cold (Adelta-fibers), and heat pain (C-fibers) were determined before and repeatedly after the blocks. RESULTS: Ischemic pain did not differ between the arms. After reflow, the thresholds for touch, warmth, and heat pain were unchanged. In the mepivacaine-treated arm, the sensibility to cold was significantly decreased 10 and 30 minutes after the block, though there was a slight decrease in skin temperature. CONCLUSIONS: There was no uniform depression of nerve function after IVRA. The cold receptors and/or their Adelta-fibers were selectively depressed after the block. In conjunction with earlier findings, this suggests that IVRA with mepivacaine can differentially decrease neurogenic inflammation, with little impairment of sensory function.

Adolescent↗
PubMedDate not supplied

Metoclopramide decreases emesis after spinal anesthesia supplemented with subarachnoid morphine.

BACKGROUND AND OBJECTIVES: The authors studied whether metoclopramide decreases the incidence of emesis after spinal anesthesia supplemented with subarachnoid morphine. METHODS: Patients underwent total hip arthroplasty under spinal anesthesia using tetracaine with norepinephrine and morphine 0.2 mg. Forty-eight patients were included in the study conducted with a paired design, using sequential analysis. Patients were allocated randomly and double-blinded to the treatment with metoclopramide or to the control group. In one group, metoclopramide 20 mg intramuscularly was given before and after surgery; patients in the control group were given equal volumes of saline. The presence of emesis for 5 hours postoperatively was recorded. RESULTS: In the postoperative period, emesis was noted in 58% of control patients but in only 17% of patients given metoclopramide (P < .05). CONCLUSIONS: The data suggest that metoclopramide is effective against postoperative emesis after spinal anesthesia supplemented with subarachnoid morphine.

Aged↗
PubMedDate not supplied

Mepivacaine as an intravenous regional block interferes with reactive hyperemia and decreases steady-state blood flow.

BACKGROUND AND OBJECTIVES: Local anesthetics block propagation in nerve fibers but may also inhibit inflammation. Inflammatory phenomena such as warmth, reddening, and swelling are intimately connected with blood flow. Our primary aim was to investigate the effect of mepivacaine on cutaneous blood flow in a situation involving hyperemia, but no inflammation, namely, after arterial occlusion. METHODS: The subjects were healthy volunteers (9 men, 7 women). Pain was evaluated by visual analog scale every 5 minutes. A laser Doppler probe was applied on each forearm. After baseline flow measurements during 30 minutes, a bilateral regional intravenous block (Bier block) was performed by injecting mepivacaine (1.4 mg/kg in 40 mL) in one arm and normal saline in the other in a randomized, controlled, double-blind manner. Arterial occlusion was maintained for 20 minutes, and flow was followed for 60 minutes after release of the block. RESULTS: The ischemic pain, though modest, was less (P = .045) in the treated arm. Following release of the cuff, the blood flow had essentially stabilized after 20 minutes. The reactive hyperemia (1-20 minutes) was attenuated in the mepivacaine-treated arm (mean, 68% of placebo, P = .025). In the 21-60-minute period, flow in this arm stabilized at a lower level (mean, 73% of placebo, P = .0013). CONCLUSION: Mepivacaine is a vasoconstrictor of long duration. This has to be taken into account when antiinflammatory effects of mepivacaine are assessed.

Adult↗