Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial

BACKGROUND: Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain. METHODS: After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n=20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lidocaine 1.5% with epinephrine 1:200000, and group LEB: lidocaine 1.5% with epinephrine 1:200000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anesthetic infiltration and epidural catheter movement during labor. RESULTS: Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular disturbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6+/-2.2 vs. 2.6+/-1.8; P=0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor. CONCLUSION: Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.     

Multiport epidural catheters: does the air test work?

BACKGROUND: Multiport epidural catheters are popular; however, the reliability of the air test has not been evaluated with this catheter design. The authors determined the effectiveness of aspirating for blood and the air test in detecting intravascular multiorifice epidural catheters. METHODS: Three hundred women in labor underwent placement of a blunt-tip, three-hole, 20-gauge, lumbar epidural catheter. If there were no signs of spinal anesthesia, 3 ml lidocaine or bupivacaine was injected and the patient was observed for signs of spinal anesthesia. If there were no signs of spinal anesthesia, the authors injected 1 ml air through the epidural catheter while listening to the maternal precordium using a Doppler fetal heart rate monitor. Catheters through which blood was aspirated were air-tested and replaced. Patients with air-test-positive, blood-aspiration-negative catheters received 100 mg lidocaine through the catheter and were questioned about toxicity symptoms. The authors injected bupivacaine-fentanyl through aspiration-negative,air-test-negative catheters and recorded the sensory analgesic level 20 min later. RESULTS: The authors aspirated cerebrospinal fluid through one catheter and documented intravascular placement in 11 catheters. Results of the air test and blood aspiration were positive for eight catheters. Blood could not be aspirated from one air-test-positive catheter; perioral numbness developed in the patient after lidocaine injection. Blood was freely aspirated from two air-test-negative catheters. In the remaining 288 catheters, bupivacaine-fentanyl injection produced epidural analgesia in 279 patients and no effect in 9 patients. CONCLUSIONS: The authors obtained false-negative results with both catheter aspiration and the air test. Fractionating the local anesthetic dose is important when using multiorifice epidural catheters.     

Periurethral collagen injection: a long-term follow-up study

OBJECTIVE: To determine the long-term success of the periurethral injection of collagen (Contigen(R), Bard UK) in women with genuine stress incontinence. PATIENTS AND METHODS: Sixty-one women with genuine stress incontinence were enrolled in a trial of periurethral collagen injections between 1 September 1990 and 31 August 1992. They were assessed at 1, 3, 6, 12 and 24 months after the last collagen injection. In 1998, their notes were reviewed, and a standardized questionnaire was sent to 46 women who were still alive and had undergone no further anti-incontinence surgery. RESULTS: Of the 53 women who were either known failures or who had follow-up information beyond 5 years, 26% were subjectively improved. Women who had a maximum urethral closure pressure of >20 cmH2O and those who had urinary incontinence for <10 years before their first injection were more likely to have had long-term success. There was no correlation between long-term success and the number of previous operations, body mass index, age or preoperative pad loss. Neither the number of injection sessions, total volume of collagen injected nor perceived bulking at the time of surgery affected long-term success rates. Of the 14 women who considered themselves subjectively improved, seven had daily incontinence and only one was completely dry. Urinary retention and urinary tract infection were the most common complications. In addition, one woman reported a flare-up of her skin test and transient 'flu-like symptoms 2 weeks after the injection, and one woman developed a right upper lobe pneumonia 2 weeks after the collagen injection. CONCLUSION: The long-term results of periurethral collagen injections are disappointing. We found no evidence to support the use of periurethral collagen injections in women with intrinsic sphincter deficiency, who had a higher failure rate than those with hypermobility. Further research is essential to develop agents that are not immunogenic, produce minimal inflammatory response and yet are durable.     

Patient tolerance during cystoscopy: a randomized study comparing lidocaine hydrochloride gel and dimethyl sulfoxide with lidocaine

PURPOSE: Cystoscopy is one of the most common examinations in urologic outpatient clinics. Various anesthetic approaches have been used to make cystoscopy more tolerable for patients. The aim of the present prospective randomized study was to evaluate the efficacy of lidocaine hydrochloride gel compared to dimethyl sulfoxide (DMSO) with lidocaine in rigid cystoscopy. MATERIALS AND METHODS: Male patients requiring 17F rigid cystoscopy were eligible for inclusion in this study. A total of 140 patients were divided into two groups: group 1 (n=70) received approximately 11 mL of 2% lidocaine gel intraurethrally, while in group 2 (n=70) approximately 10 mL of 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel was smeared around the scope and external urethral meatus. A penile clamp was placed for 15 minutes and 5 minutes in group 1 and group 2, respectively. Immediately after cystoscopic examination pain was scored on a 10-cm visual analog scale. RESULTS: The mean pain scores after the procedure for group 1 and group 2 were 3.9+/-1.1 and 2.1+/-1.0, respectively. The pain scores were significantly lower for group 2 than for group 1 (P=0.015). No patients needed additional anesthetic agents or sedatives due to insufficient analgesia, and there were no serious side effects in either group. CONCLUSIONS: Our study has shown that DMSO with lidocaine gel causes significantly less delivery discomfort in the male urethra than lidocaine hydrochloride gel. The advantages of DMSO with lidocaine are the mixture takes less time to act and had lower pain scores.     

Lack of local anesthetic properties of lidocaine gel in an experimental model

INTRODUCTION: Many reports negate the anesthetic properties of lidocaine gel placed in the urethra during catheterization. The anesthetic action of lidocaine is inseparably associated with the toxic action of this compound on cells. MATERIALS AND METHODS: A primary rabbit urothelial cell culture (PRUCC) was previously established as a monolayer. The effect of 2% lidocaine gel on the viability of the PRUCC was assessed and compared with the cytotoxic effect of decreasing concentrations of lidocaine solution. Cell viability was evaluated after 1-hour exposure using the trypan blue exclusion test. RESULTS: The 2% lidocaine gel did not show cytotoxic properties after 1 h of incubation on a PRUCC. The 2 and 1% lidocaine solutions induced statistically significant decreases in the viability of the PRUCC after 1 h of incubation. CONCLUSIONS: Experimental tests evaluating the cytotoxicity of local anesthetics may prove to be an objective measure of the accessibility of these substances to cells and their anesthetic action.     

Treatment of Incomplete Analgesia after Placement of an Epidural Catheter and Administration of Local Anesthetic for Women in Labor

Background: Approximately 15% of women still have pain after placement of an epidural catheter and administration of local anesthetic for labor analgesia. Two techniques frequently used to treat this pain were compared: (1) withdrawal of the catheter 1 cm and repeated dosing with additional local anesthetic, and (2) repeated dosing with additional local anesthetic without any catheter manipulation.

Methods: Fifteen minutes after placement of a multiple-orifice epidural catheter 5 cm into the epidural space and administration of 13 ml 0.25% bupivacaine to the parturient in labor, the adequacy of analgesia was assessed. All women who had incomplete analgesia were randomized (first intervention) to receive and additional 5 ml 0.25% bupivacaine (local-anesthetic-only only group) or to receive 5 ml 0.25% bupivacaine after first withdrawing the epidural catheter 1 cm (catheter-manipulation group). If after 15 min the woman still bad pain, then (second intervention) the catheter was withdrawn 1 cm and an additional 5 ml 0.25% bupivacaine was administered to the local-anesthetic-only group, whereas 5 ml 0.25% bupivacaine was given to the catheter-manipulation group without further catheter manipulation. The success rate of the second intervention was assessed 15 min later.

Results: Seventy-eight women were enrolled in the study, 39 to each group. In the local-anesthetic-only group, 29 (74%) women were successfully treated with the first intervention and remaining 10 (100%) were successfully treated with the second intervention. In the catheter-manipulation group, 30 (77%) were successfully treated with the first intervention and 7 (100%; 2 patients were not studied because of investigator error) were successfully treated with the second intervention (P = NS).     

Does epinephrine improve the diagnostic accuracy of aspiration during labor epidural analgesia?

Aspiration reliably detects almost all IV multiorifice epidural catheters. Although a supplemental epinephrine 15-microg test dose may detect the rare IV catheter that does not yield blood on aspiration, false-positive epinephrine responses may cause some women to unnecessarily undergo repeat epidural catheter insertion. We evaluated 532 consecutive eligible patients requesting neuraxial labor analgesia. Patients were excluded if they had a contraindication to epinephrine or if they received intrathecal sufentanil/bupivacaine. Multiorifice catheters were inserted 4-6 cm into the epidural space as part of an epidural (n = 305) or combined spinal-epidural (n = 270) technique. We used aspiration, a lidocaine/epinephrine test dose, and bolus injection or infusion of dilute bupivacaine/sufentanil solutions to systematically determine IV, intrathecal, or epidural catheter location. Aspiration alone detected 47 of 48 intravascular catheters. There were 10 positive epinephrine responses: 2 were true positives, 7 were falsely positive (subsequent local anesthetic injection/infusion produced bilateral sensory change and analgesia), and 1 catheter was removed without further testing. Aspiration detected almost all intravascular catheters. Although the epinephrine test dose did detect one catheter that proved to be in a blood vessel, 87.5% of positive responses occurred in women without intravascular catheters. IMPLICATIONS: Epidural catheters may enter a blood vessel. Many clinicians use epinephrine to detect these catheters. Because aspiration alone detects almost all IV multiorifice catheters in laboring women, a subsequent epinephrine test dose may be unnecessary.     

Use of a new local anesthesia – intracorpus spongiosum anesthesia – in procedures on anterior urethra

BACKGROUND: Urologists often perform procedures on anterior urethra, which is one of the most sensitive parts in male patients. The aim of the present study was to determine the efficacy of intracorpus spongiosum anesthesia during procedures on anterior urethra in the outpatient clinic. METHODS: A dosage of 3 mL of 1% lidocaine was slowly injected into the glans penis of 51 male patients. Immediately following injection, they underwent different procedures on anterior urethra. The subjective experience of pain in the patients was assessed by questionnaire according to a pain scale. RESULTS: Forty-seven patients (92.16%, 47/51) had zero pain and four cases (7.84%) had either minor or moderate discomfort, which was limited and tolerable. The anesthetic effect is immediate and has been very satisfactory. All the procedures (mean duration, 33 min), were successfully completed under the intracorpus spongiosum anesthesia. The act of injection into the glans caused instantaneous minor pain in 45 patients (88.23%, 45/51), moderate pain in four patients and no pain in two patients. There were no serious complications with this anesthetic technique, although two cases had instantaneous trance during injection of lidocaine. CONCLUSIONS: Minor procedures on anterior urethra in an outpatient setting with intracorpus spongiosum anesthesia are generally painless, safe, simple, successful and inexpensive compared to those performed in a hospital.     

Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change

Objective: To evaluate the role of intravesical lidocaine in preventing autonomic dysreflexia (AD) during routine catheter changes in individuals with spinal cord injury (SCI) at T6 or above.

Design: Prospective observational cohort study.

Setting: Outpatient urology clinic.

Participants: Fifty consecutive individuals with SCI at or above T6 and a history of AD having a routine indwelling catheter change.

Interventions: A treatment group of individuals received 10?ml of 2% lidocaine administered into the existing catheter 4–6 minutes prior to catheter change. The control group had the same amount of lidocaine administered into the urethra or suprapubic tract after removing the old catheter and immediately prior to inserting the new catheter (due to the delayed onset of action of the anesthetic, this was assumed to have no initial effect). Systolic blood pressures (SBP) were measured immediately after catheter insertion and then every 30–45 seconds for 5 minutes.

Outcome measures: Incidence and magnitude of AD as determined by SBP following catheter change.

Results: The incidence of AD in the lidocaine treatment group was 14.8% vs 47.8% in the control group (P?=?.011). Pretreatment with lidocaine also demonstrated a significantly attenuated rise in SBP immediately after the catheter change (9.5?mmHg vs 26.9?mmHg for post-treatment, P?=?.014) relative to baseline SBP.

Conclusion: In individuals with SCI at risk of AD, pretreatment with intravesical lidocaine prior to catheter change significantly decreased both the incidence and magnitude of AD. This suggests that pretreatment with intravesical lidocaine is helpful in individuals with SCI who are prone to AD.     

Epidural analgesia for labor: safety and success

Safe and successful provision of epidural analgesia for labor requires an understanding of the risks of the technique and attention to detail when performing the technique. The frequency of the commonest complication of epidural analgesia, accidental dural puncture, can probably best be minimized by regular practice of the technique. Some catheters, intended for the epidural space, will find themselves intrathecal, intravascular, or subdural. Although such misplacements probably cannot be prevented, their consequences can be minimized by careful, incremental injection of small doses of local anesthetic. The traditional epidural “test dose” of 45 mg of lidocaine and 15 μg of epinephrine can have undesired effects when injected intrathecally, intravenously, or epidurally. Successful epidural analgesia requires first placing a catheter in the epidural space. The combined spinal epidural technique is a very reliable way to accomplish this task. Subsequently, an appropriate dose of drug must be injected or infused by using an effective delivery system. Continuous infusion of ultra-dilute solutions of local anesthetics and opioids will relieve labor pain in some women, but the frequent need for supplemental medications severely limits their efficacy. Patient-controlled epidural analgesia, using slightly more concentrated local anesthetic solutions produces excellent analgesia with less local anesthetic and less need for rescue medication than continuous infusion techniques.     

Identification of the epidural space: loss of resistance with air, lidocaine, or the combination of air and lidocaine

The ideal technique for identifying the epidural space remains unclear. Five-hundred-forty-seven women in labor who requested epidural analgesia were randomly allocated to three groups according to the technique by which the epidural space was identified: 1) loss-of-resistance with air (air; n = 180), 2) loss-of-resistance with lidocaine (lidocaine; n = 185), and 3) loss-of-resistance with both air and lidocaine (air-plus-lidocaine; n = 182). We assessed ease of epidural catheter insertion, characteristics of the blockade, quality of analgesia, and complications. The inability to thread the epidural catheter occurred in 16% of the air, 4% of the lidocaine, and 3% of the air-plus-lidocaine patients (P < 0.001). More patients from the air group had unblocked segments (6.6% versus 3.2% and 2.2%, respectively; P < 0.02). The incidence of accidental dural puncture was greater in the air group (1.7% versus 0% in the other two groups; P < 0.02). Pain scores, time to onset of analgesia, upper sensory level, motor blockade, and the incidence of hypotension, transient neurological deficits, postpartum urinary retention, and postdural puncture headache were comparable. Identification of the epidural space with air was more difficult and caused more dural punctures than with lidocaine or air plus lidocaine. Additionally, sequential use of air and lidocaine had no advantage over lidocaine alone.     

PREPUBIC URETHRECTOMY WITH URETHRAL STRIPPING

PURPOSE: Prepubic urethrectomy is a simple, safe alternative to perineal urethrectomy. The lithotomy position can be avoided and, thus, operative time and risk of deep venous thrombosis are decreased. We developed a simple modification because of difficulty in dissecting the bulbous urethra. MATERIALS AND METHODS: From 1996 through 1998 prepubic urethrectomy was performed using a modified procedure in 21 patients with invasive bladder carcinoma undergoing radical cystectomy and supravesical diversion. After periurethral mobilization the urethra was cannulated with an 18F catheter, sutured distal and stripped free. RESULTS: Operative time decreased to 20 to 30 minutes with no significant postoperative complications. CONCLUSIONS: Our modification of prepubic urethrectomy is safe, fast and easy.     

Epidural bolus injection with alkalinized lidocaine improves blockade of the first sacral segment — a brief report

PURPOSE: It has been reported that the addition of epinephrine and/or bicarbonate to local anesthetic enhances the depth of epidural blockade and that initial partial bolus injection results in greater caudal spread. We evaluated the anesthetic effects of lidocaine with epinephrine and/or bicarbonate injected into the epidural space by bolus or catheter injection. METHODS: Forty-four patients undergoing epidural anesthesia with 17 mL of 2% lidocaine containing 1:200,000 epinephrine at L4-5 or L5-S1 were randomly divided into four groups. Lidocaine was administrated via epidural catheter [lidocaine catheter (LC) group] or Tuohy needle (lidocaine bolus group), lidocaine-bicarbonate was administrated via catheter (lidocaine-bicarbonate catheter group) or needle [lidocaine-bicarbonate bolus (LBB) group]. Pain threshold after repeated electrical stimulation was performed at L2 and S1 regions. Motor blockade was evaluated using the Bromage scale. Sympathetic blockade was assessed with plethysmographic waveforms from the toe. RESULTS: The pain threshold of the S1 dermatome in LBB group was significantly higher than in the lidocaine only groups, however, differences in the pain threshold at the L2 dermatome among the groups were insignificant. The onset of sensory blockade in the S1 dermatome in the LBB group was significantly shorter than in the LC group. Significantly greater motor blockade was achieved in the lidocaine-bicarbonate groups than in the lidocaine-only groups. The amplitude of plethysmographic waveforms significantly increased within each group. CONCLUSION: Epidural bolus injection of lidocaine-bicarbonate with epinephrine improves the pain threshold and speeds the onset of the blockade of the first sacral region.     

Anesthetic management of a patient with a giant bulla and liver cirrhosis using a laryngeal mask airway and epidural analgesia]

A laryngeal mask airway (LMA) and epidural analgesia were used for anesthetic management of microwave coagulo-necrotic therapy for multiple hepatoma in a 76-year-old male with a giant bulla and liver cirrhosis. Since bleeding times, PT and APTT were within normal limits, an epidural catheter was inserted between Th9 and 10 interspaces in operating room. After preoxygenation, general anesthesia was induced with propofol 120 mg. After insertion of a LMA, anesthesia was maintained under spontaneous breathing with sevoflurane (1-1.5%) in about 45% oxygen and nitrogen. During the operation, 2% lidocaine was injected continuously into the epidural space. Continuous epidural injection of 2% lidocaine was found to be very effective for obtaining abdominal muscle relaxation and perioperative pain management. Postoperative chest X ray did not show any signs of rupture of the giant bulla, and any neurological abnormalities due to the epidural hematoma were not encountered. We could reduce the risk of rupture of a giant bulla during general anesthesia using a LMA and epidural analgesia.     

Effect of prior anesthetic solution on epidural morphine analgesia.

The quality and duration of analgesia and incidence of side effects following epidurally administered morphine after cesarean section are highly variable. Two suggested sources of this variability are prior use of epinephrine-containing solutions, which may enhance both analgesia and side effects of morphine, and prior use of 2-chloroprocaine, which may inhibit epidural morphine analgesia. To examine these proposed sources of this variability we performed two studies. In the first, designed to test epinephrine's effect, 30 women underwent testing for epidural catheter tip location with injection of 2-chloroprocaine, followed by either 0.5% bupivacaine alone or 0.5% bupivacaine with 5 micrograms/mL epinephrine for epidural anesthesia. Inclusion of epinephrine with bupivacaine decreased the bupivacaine dose needed to achieve a T-4 sensory block by 24% (P less than 0.05), but did not alter analgesic duration or the incidence of side effects of epidural morphine (5 mg). In the second study, designed to test the effect of 2-chloroprocaine, 30 women received 7 mL of either 2% 2-chloroprocaine or lidocaine for epidural catheter testing, followed by 0.5% bupivacaine for epidural anesthesia. Compared to lidocaine testing, 2-chloroprocaine decreased the duration of epidural morphine analgesia (median 16 h with 2-chloroprocaine vs 24 h with lidocaine; P less than 0.05) without altering the incidence of side effects. The authors conclude that addition of epinephrine to local anesthetic does not increase the incidence of side effects or the analgesic effect from epidurally administered morphine. 2-Chloroprocaine, even when administered in small doses remote to the time of morphine injection, interferes with the duration of epidural morphine analgesia.     

Lidocaine hydrochloride versus lidocaine bicarbonate for epidural anesthesia in outpatients undergoing arthroscopic surgery

In a randomized, double-blind study, 24 patients undergoing outpatient arthroscopic knee surgery were divided into two groups. Group 1 received 2% lidocaine hydrochloride; group 2 received pH-adjusted 1.73% lidocaine made by adding 1 ml of NaHCO3 44.6 meq/L to 10 ml of 2% lidocaine hydrochloride. Epidural anesthesia was administered in the sitting position. Group 1 consisted of 12 males; group 2 consisted of 6 males and 6 females (p less than 0.01). Statistical analysis using the unpaired Student's t-test and the Mann-Whitney test found no significant differences between the two groups regarding time of onset of analgesia, degree of spread of analgesia, time to maximum motor blockade, degree of motor blockade, length of surgical procedure, total anesthesia time, regression of anesthesia, dosage of lidocaine used, and serum lidocaine levels. Intraoperative conditions were satisfactory in all cases. Postoperatively, all patients reported having experienced a satisfactory anesthetic without any complications. The authors conclude that epidural anesthesia is a satisfactory technique for outpatient arthroscopic surgery. There appears to be no advantage to adding bicarbonate to lidocaine anesthetic solutions for use in epidural anesthesia.     

Discomfort associated with regional anesthetic placement in obstetrics: does alkalinization help?

Lidocaine is commonly used prior to intravenous catheter insertion as well as before instituting a regional anesthetic[ but it often causes a burning discomfort during injection. We undertook this study to determine if the addition of bicarbonate to lidocaine would decrease the discomfort associated with the initiation of regional anesthesia in obstetrics. Forty patients who were scheduled for elective cesarean section or who were in active labor were selected. Lidocaine was prepared before infiltration using 9 ml of preservative-free 1% lidocaine with either 1 ml of preservative-free normal saline or 1 ml of sodium bicarbonate (1 mEq.ml(-1)). A skin wheal was raised with 0.5 ml of the solution; the remainder (1.5 ml) was injected into the deep tissues. Pain was assessed using visual analog scales on three occasions, immediately after lidocaine placement, following introducer needle insertion (in the spinal group) or following epidural needle insertion (in the epidural group), and following the successful placement of the local anesthetic (in the spinal group) or the epidural catheter (in the epidural group). There was no difference in the visual analog scale scores at any of the assessment periods. We found no benefit from adding sodium bicarbonate to lidocaine used for infiltration before needle placement when initiating an obstetrical regional anesthetic.     

Brief report: A randomized controlled trial of Synera™ versus lidocaine for epidural needle insertion in labouring parturients

PURPOSE: Skin infiltration with lidocaine, although brief, can be very stressful, painful, and may perpetuate anxiety. Synerat, a local anesthetic patch, which contains an oxygen-activated heating component to enhance the delivery of a eutectic mixture of lidocaine (70 mg) and tetracaine (70 mg), has provided analgesia for minor, dermatological procedures. We hypothesized that the analgesic effect of Synera, for pain in labouring parturients, would be superior to the traditional infiltration of lidocaine prior to epidural needle insertion. METHODS: With Institutional Review Board approval, we recruited women, who consented to epidural labour analgesia and who met the following criteria: older than 18 yr; body mass index less than 45 kg x m(-2); and with no history of hypersensitivity to any study medications. We randomized the labouring parturients into Synera (SS) or placebo (PL) groups. Group SS received the Synera patch and infiltration with saline prior to epidural needle insertion. Group PL received a placebo patch and infiltration with 2% lidocaine. RESULTS: The groups were similar with respect to age, estimated gestational age, gravidity, parity, and body mass index. The subjects' pain, with epidural placement, was significantly greater in the SS group (P < 0.001). More SS subjects required additional, deep, local anesthetic infiltration compared to PL (P = 0.02). CONCLUSION: The Synera patch provided inferior analgesia, for performing epidural labour analgesia in labouring parturients, compared to traditional infiltration with 2% lidocaine.     

Multiport Epidural Catheters: Does the Air Test Work?

Background: Multiport epidural catheters are popular; however, the reliability of the air test has not been evaluated with this catheter design. The authors determined the effectiveness of aspirating for blood and the air test in detecting intravascular multiorifice epidural catheters.

Methods: Three hundred women in labor underwent placement of a blunt-tip, three-hole, 20-gauge, lumbar epidural catheter. If there were no signs of spinal anesthesia, 3 ml lidocaine or bupivacaine was injected and the patient was observed for signs of spinal anesthesia. If there were no signs of spinal anesthesia, the authors injected 1 ml air through the epidural catheter while listening to the maternal precordium using a Doppler fetal heart rate monitor. Catheters through which blood was aspirated were air-tested and replaced. Patients with air-test-positive, blood-aspiration-negative catheters received 100 mg lidocaine through the catheter and were questioned about toxicity symptoms. The authors injected bupivacaine-fentanyl through aspiration-negative,air-test-negative catheters and recorded the sensory analgesic level 20 min later.

Results: The authors aspirated cerebrospinal fluid through one catheter and documented intravascular placement in 11 catheters. Results of the air test and blood aspiration were positive for eight catheters. Blood could not be aspirated from one air-test-positive catheter; perioral numbness developed in the patient after lidocaine injection. Blood was freely aspirated from two air-test-negative catheters. In the remaining 288 catheters, bupivacaine-fentanyl injection produced epidural analgesia in 279 patients and no effect in 9 patients.     

尿道海绵体麻醉在前尿道和阴茎头小手术中的应用

目的：确定尿道海绵体麻醉在实施前尿道和阴茎头手术操作中的麻醉效果。方法：将1％～2％的利多卡因2～3ml缓慢注射入阴茎头海绵体。随后进行前尿道和(或)阴茎头手术操作。根据疼痛分级标准,评估患者对疼痛的主观感觉。结果：阴茎头注射利多卡因后,立刻产生麻醉止痛作用。69例中,63例无疼痛,6例诉偶有不适或轻微疼痛,但均能耐受。在尿道海绵体麻醉下,所有手术操作均圆满完成。手术时间达68min而无须任何静脉镇静剂或强化止痛处理。本组患者中无严重麻醉并发症。结论：尿道海锦体麻醉是一种效果可靠、操作简单、安全的局部麻醉技术,在阴茎头和前尿道病变的手术治疗中,可常规使用此局部麻醉。由于有了这种新型局部麻醉方法,许多阴茎头和前尿道手术操作的总费用明显降低。