Biomedical subjects

D Celleno

Publications and source records attributed to D Celleno.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Maternal analgesia and neonatal effects of epidural sufentanil for cesarean section.

This study was designed to evaluate the maternal intraoperative and postoperative analgesia and neonatal effects of adding sufentanil to epidural anesthesia for cesarean section before the skin incision. Forty-five multipara were randomized in three equal groups to receive sufentanil 80 micrograms, 50 micrograms, or saline with the epidural lidocaine. Intraoperative and postoperative analgesia and side effects were recorded. Infants were evaluated by Apgar score at one and five minutes and by Neurologic and Adaptive Capacity Score and Early Neonatal Neurobehavioral Scale at one, four and 24 hours of life. Superior analgesia, with no intraoperative requirements for supplemental narcotics, was obtained when either 80 micrograms or 50 micrograms sufentanil were added to lidocaine. Postoperative analgesia was prolonged after sufentanil, but side effects increased with the greater dose. The infants whose mothers received 80 micrograms sufentanil showed a mild neurobehavioral depression. It is therefore concluded that the addition of 50 micrograms of sufentanil improves both intraoperative and postoperative analgesia without significant neonatal effects.

Adult↗

PubMedDate not supplied

[Continuous intravenous infusion with patient-controlled anesthesia for postoperative analgesia in cesarean section: morphine versus buprenorphine].

A double blind comparison between morphine and buprenorphine was performed in 20 patients using a new demand and continuous infusion analgesic system to provide analgesia after cesarean section. The patients were randomized in two equal groups to receive either morphine 1 mg/h or buprenorphine 0.03 mg/h. The PCA system was set to deliver bolus of either morphine 1 mg or buprenorphine 0.03 mg, with a lockout interval of 10 and 15 min respectively. A loading dose of morphine 5 mg or buprenorphine 0.15 mg was given if necessary. The quality of analgesia, assessed by a visual analogue and a subjective scale was good with both drugs. No difference in side effects between the groups was observed. The mean potency ratio between buprenorphine and morphine was 32:1. Patients receiving buprenorphine showed a more prolonged analgesia and a significant improvement of sedation score.

Adult↗

PubMedDate not supplied

Addition of clonidine to epidural morphine enhances postoperative analgesia after cesarean delivery.

BACKGROUND AND OBJECTIVES: The randomized, double-blind, dose-response study was designed to evaluate the effects of the addition of clonidine to epidural morphine on postoperative analgesia and side effects in patients undergoing cesarean delivery. METHODS: Sixty patients, undergoing cesarean delivery under epidural anesthesia, were randomly divided in three equal groups to receive, at the end of surgery, an epidural analgesic mixture consisting of 10 mL solution containing 2 mg of morphine diluted with 0.125% bupivacaine plus 1:800,000 epinephrine and 0, 75, or 150 micrograms of clonidine. Duration of analgesia was assessed as the pain-free interval between the end of surgery and patient's first analgesic request. The analgesic mixture was repeated, on patient's request, to 36 hours after the operation. Arterial blood pressure, heart rate, respiratory rate, and side effects were noted. The total amount of morphine and clonidine delivered was also noted. RESULTS: The addition of clonidine (0, 75, or 150 micrograms) to morphine significantly increased the duration of postoperative analgesia (P < .0001) (6.27 versus 13.25 and versus 21.55 hours) and reduced the mean total dose of morphine (9.40 mg versus 5.0 mg versus 3.60 mg) (P < .0001). No significant differences in side effects were noted. CONCLUSIONS: A low dose of clonidine such as 75 micrograms doubled the duration of analgesia produced by 2 mg of morphine and a dose of 150 micrograms further increased the duration of postoperative complete analgesia without increasing the incidence of side effects. The morphine requirements during the postoperative period (36 hours) was greatly reduced by the addition of clonidine to the analgesic epidural mixture.

Adult↗

PubMedDate not supplied

An anatomic study of the effects of dural puncture with different spinal needles.

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the effects of puncture of lumbar dura mater with needles of different sizes and with bevels of different shapes. METHODS: After removal, the dura was punctured with different needles (22-, 25-, 27-, and 29-gauge Quincke, 24-gauge Sprotte, 22-gauge Whitacre, and 18-gauge Tuohy needles) and observed by stereomicroscope to examine the gross morphology. Histologic features were observed by light microscope using frozen and fixed samples stained with hematoxylin and eosin or specific methods (Masson and Weigert) to evidence elastic or collagen fibers. RESULTS: Puncture hole size was proportional to the size of the needle used. Quincke type needles determined oval or ellipsoidal holes; pencil-point needles determined more rounded holes. Dural retraction determined a reduction of the holes in all cases. Histologic examination revealed an irregular border of the hole, with sectioned as well as compressed fibers. The pattern of compressed but not sectioned fibers was observed more frequently in the samples punctured by pencil-point needles. CONCLUSIONS: This study confirms that the arrangement of dural fibers is not as uniform as previously thought. Histologic findings confirm the current opinion that pencil-point needles may be less traumatic than Quincke-type needles. The direction of the bevel of the needle does not appear to have great importance in determining the shape of the hole.

Aged↗

PubMedDate not supplied

Alkalinization of local anesthetics. Which block, which local anesthetic?

BACKGROUND AND OBJECTIVES: A number of clinical studies have been performed in an attempt to establish the effects of alkalinization on potency of local anesthetics. Conflicting results were obtained probably because different studies used different methods as well as different definitions of the effects. To determine the efficacy of alkalinization using different local anesthetic solutions and different regional blocks, 180 patients were studied in a randomized, double-blind fashion. The local anesthetic solutions studied were bupivacaine, mepivacaine, and lidocaine; the regional blocks studied were epidural block, axillary brachial plexus block, and femoral and sciatic nerve block. MATERIALS AND METHODS: In this study, 180 patients receiving epidural block (n = 60), sciatic and femoral nerve block (n = 60), and brachial plexus block (n = 60) were randomized to receive, in a double-blind fashion, a plain or a pH-adjusted solution of 2% mepivacaine, 2% lidocaine, or 0.5% bupivacaine. Onset of sensory analgesia, onset of maximum effect (peak effect or complete analgesia), duration of the block, onset, duration and density of motor block were evaluated using pinprick (Hollmen scale) and a 10-point decimal scale (Seow scale). RESULTS: concerning epidural block, the alkalinization of the local anesthetic shortened significantly the onset of sensory analgesia in the dermatome corresponding to the lumbar interspace used for epidural puncture (L3-L4) and increased the spread of the epidural block in all the groups. The onset of sensory analgesia at L4 level ranged from 10 minutes for plain bupivacaine to 3 minutes for alkalinized lidocaine, whereas the onset at T10 level ranged from 16 minutes for plain bupivacaine and mepivacaine to 12.3 minutes for alkalinized lidocaine. The effects of alkalinization were more evident with lidocaine and bupivacaine. Concerning femoral and sciatic nerve blocks, a statistically significant shorter onset of sensory analgesia and motor block were observed with mepivacaine. Concerning brachial plexus axillary block, the effects of alkalinization were more evident with lidocaine. CONCLUSIONS: Alkalinization produced the best results with lidocaine and bupivacaine for epidural block, with lidocaine for brachial plexus block, and with mepivacaine for sciatic and femoral nerve blocks.

Adult↗