Bilateral multi-injection iliohypogastric-ilioinguinal nerve block in conjunction with neuraxial morphine is superior to neuraxial morphine alone for postcesarean analgesia.

STUDY OBJECTIVE: To determine whether bilateral iliohypogastric and ilioinguinal (IHII) peripheral nerve blocks, given in conjunction with neuraxial morphine, reduce postcesarean analgesic requirements and side effects, resulting in improved maternal satisfaction. DESIGN: Randomized, prospective, double-blinded, placebo-controlled study. SETTING: Labor and delivery suite at Johns Hopkins Hospital. PATIENTS: 34 women scheduled for elective cesarean delivery. INTERVENTIONS: Patients were randomized to receive IHII nerve blocks bilaterally, with either total 24 mL of 0.5% bupivacaine or normal saline, following cesarean delivery via Pfannensteil incision with a standard intrathecal dose of 12 mg of 0.75% bupivacaine with 10 µg of fentanyl and 200 µg of preservative-free morphine. MEASUREMENTS: Patients were assessed at 0, 6, 12, 18, and 24 hours postoperatively. Visual analog scale (VAS) pain scores at rest were recorded at each time period. Analgesic use, patients' perception of nausea, vomiting, pruritus, and their overall satisfaction with their analgesia were recorded for the first 24 hours. MAIN RESULTS: Lower VAS pain scores were seen in the bupivacaine group at 6, 12, 18, and 24 hours postoperatively (P = 0.01, P < 0.01, 0.02, and 0.04, respectively). A longer mean time to first rescue dose of ketorolac was noted in the bupivacaine group (14.3 ± 1.8 hrs) than the saline group (mean 5.6 ±1.1 hrs), (P < 0.01). Fewer patients in the bupivacaine group made requests for acetaminophen 500 mg/oxycodone 5 mg in the first 24 hours. Satisfaction was greater in the bupivacaine group. No difference in side effects was noted between groups. CONCLUSIONS: Bilateral multilevel injection IHII nerve blocks result in lower resting VAS pain scores, lower analgesic requirements, and greater satisfaction following cesarean delivery in patients who received neuraxial morphine.

Accidental subcutaneous remifentanil infusion as a cause of delayed awakening after craniotomy.

We report a case of accidental subcutaneous infusion of remifentanil as a cause of delayed awakening after a craniotomy.

Neuraxial anesthesia for labor and cesarean delivery in a parturient with hereditary antithrombin deficiency on recombinant human antithrombin infusion therapy.

A recombinant human antithrombin (rhAT; generic name: antithrombin Alfa) has recently been developed. A 37 year-old parturient with hereditary antithrombin deficiency, receiving rhAT infusion therapy, who successfully received an epidural catheter for analgesia and anesthesia during labor and cesarean delivery, is presented.

Use of spinal anesthesia does not reduce intraoperative blood loss.

OBJECTIVES: To determine whether the use of spinal anesthesia (versus general anesthesia) will result in lower intraoperative blood loss for radical retropubic prostatectomy. METHODS: The patients' charts for one urologist from July 1999 through June 2005 were obtained and reviewed. The data extracted included demographic and perioperative data, including operative time, estimated blood loss, and length of stay. RESULTS: A total of 1084 charts of radical retropubic prostatectomy patients were obtained and reviewed. No difference was found in the demographic or perioperative data between those who received spinal or general anesthesia. Patients who received spinal anesthesia actually had a greater mean intraoperative blood loss than those who received general anesthesia (1125.9 +/- 576.0 mL versus 1005.7 +/- 518.5 mL, P = 0.60). CONCLUSIONS: Our results suggest that the type of anesthesia (spinal versus general) does not significantly influence the extent of intraoperative blood loss.