Caudal anesthesia appears to be a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. From January 1990 to December 1992, we examined the trend and distribution of the 1038 cases of caudal anesthesia retrospectively according to year, age, surgieal department, type of operation, operation time, local anesthetics and suecess rate. Annual numbers of caudal anesthesia increased with years and the first decade of life was the greatest number. The most common department and operation time were general surgery and 30~60 minutes. 2% or 1% lidocaine with epinephrine was the major local anesthetics used during caudal anesthesia and overall success rate was 95.5%.
Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics, Local ; Epinephrine ; Lidocaine ; Narcotics ; Retrospective Studies ; Umbilicus

After an accidental experience of epidural anesthesia by Corning in 1885, the development of Tuohy needle, the discovery of a better local anesthetic, epidural anesthesia came into common usage in clinical anesthesia. Epidural anesthesia is more modern as a regional anesthesia than spinal anesthesia because of the low incidence of hypotension, controllability of the duration of anesthesia time, and the absence of postspinal headache. A total of 1,168 epidural anesthesia cases encountered in Severance hospital during the period of January 1, 1978 to December 31, 1982 were subjected to this clinical evaluation. The results are as follows: 1) The percentage of epidural anesthesia comprised 2.8% of total anesthesia cases. 2) The most common age groups listed in order of decreasing grequency were those in the seventh decade, third decade, and sixth decase. 3) The most common ASA physical status listed in order of decreasing frequency were those in the Class ll, Class l, Class lll. 4) The common agents of local anesthetics used were 1.5 or 2% lidocaine and sometimes bupivacaine. Additive agents such as morphine sulfate for postoperative pain control and epinephrine for prolongation of anesthesia time were used commonly. 5) The most common site of anesthesia was the sixth thoracic vertebral sensory segmental level, but a higher site for sensory anesthesia than required for the operation performed was frequently encountered. 6) The most common complications of epidural anesthesia were hypotension(21.1%) with infrequently dural puncture, traumatic tapping, bradycardia, convulsion, and catheter sequestration. In conclusion, epidural anesthesia is considered to be a safe regional anesthesia that will reduce the incidence of hypotention provided that careful control of the sensory level to be anesthetized is taekn under consideration along with the age, physical status, and operation site of the patient.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics, Local ; Bradycardia ; Bupivacaine ; Catheters ; Epinephrine ; Headache ; Humans ; Hypotension ; Incidence ; Lidocaine ; Morphine ; Needles ; Pain, Postoperative ; Punctures ; Seizures ; Zea mays

Since Sicard, Cathlin and Tuffier performed the first sacral extradural anesthetic technique in 1901, surprisingly increased interest in this technique and basic investigation has been done concerning the anatomy, the physiology, and the fate of the local anesthetic in the body, after in jection in the epidural space. Recently, a decreasing interest in peridural anesthesia and nerve block thechniques have resulted from the availability of more efficacious and more safe volatile anesthetics. However in case of contraindication of both general and spinal anesthesia, this caudal anesthesia should be available and very usefull. Authers have undertaken to evaluate the circulatory effect of caudal anesthesia with the injection of lidocain into the epidural space through the sacral hiatus. Ten cases were selected and observed the change of the cardiovascular system before and after caudal anesthesia. The changes of the heart rate and systolic blood pressure between pre-and post anesthesia were insignificant statistically.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics ; Blood Pressure ; Cardiovascular System ; Epidural Space ; Heart Rate ; Lidocaine* ; Nerve Block ; Physiology

Interscalene bracheal plexus block has became a popular method of anesthesia for surgical operation on the upper extremities. Possible complications are subarachnoid block, epidural block, phrenic nerve block, vagus or recurrent laryngeal nerve block, sympathetic nerve block, intravascular injection. But reported complications has been few and generally without prolonged effects. The following describes a patient who developed signs and symptoms suggestive of inadvertent phrenic nerve block and epidural anesthesia as complications of interscalene bracheal plexus block The complications were attributed to using of inferomedially directed 5 cm needle and then additional blind block of the brachial plexus with 5 or 6 times. We emphasize that if the appropriate length of needle and technique are not used, phrenic nerve paralysis and serious complications including total spinal or epidural block can occur as a result of a medially misdirected needle.
Anesthesia ; Anesthesia, Epidural ; Autonomic Nerve Block ; Brachial Plexus ; Humans ; Needles ; Paralysis* ; Phrenic Nerve* ; Recurrent Laryngeal Nerve ; Upper Extremity

Regional anesthesia for Cesarean section is a popular anesthetic method and a subarachnoid injection of local anesthetics provides rapid onset and a reliable block. Furthermore, it maintains airway reflexes and consciousness of the parturient and is associated with less neonatal depression. Complications related with spinal anesthesia are most often postdural puncture headache, back pain, hematoma, abscess, paresthesia or motor weakness and very rarely, myoclonus. Generalized seizures as a complication following epidural anesthesia with bupivacaine has been reported, but rarely following spinal anesthesia. We present a case of a parturient who was well antenatally, but presented with generalized tonic-clonic seizures following delivery. Although the possible etiologic factors of these transient seizures after spinal anesthesia are difficult to clarify, we emphasize that careful airway monitoring after regional anesthesia is important.
Abscess ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics, Local ; Back Pain ; Bupivacaine ; Cesarean Section ; Consciousness ; Depression ; Female ; Hematoma ; Myoclonus ; Paresthesia ; Post-Dural Puncture Headache ; Pregnancy ; Reflex ; Seizures

A patient who has undergone central neural blockade requires monitoring until the block shows signs of resolution. Residual effects of sedative and general anesthetic agents can result in difficulty evaluating the extent of neural blockade.
Human ; Male ; Adult ; ANESTHESIA ; HEMATOMA, EPIDURAL, SPINAL ; ANESTHESIA, CONDUCTION

OBJECTIVE: Recently, the cases about successful regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block for clavicle surgery have been reported. The aim of this study was to compare regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block with general anesthesia. METHODS: In this prospective randomized study, 26 patients scheduled for elective clavicle surgery were divided into two groups: the first group was general anesthesia group (GA group, n=13) and the second group for peripheral nerve block group (PNB group, n=13). Standardized general anesthesia was done to the patients assigned to the GA group and ultrasonography-guided combined superficial cervical plexus block and interscalene brachial plexus block was done to the patients assigned to the PNB group. Postoperative sedation scale was assessed at post-anesthesia care unit, and pain scale using 10-cm Visual Analog Scale (VAS) was assessed at immediate postoperative, 30 minutes, 1 hour, 6 hours, and 24 hours. Patients needed additional analgesics, and time for first analgesic demand and duration from surgery to discharge was recorded. RESULTS: The pain VAS scales were less in PNB group than GA group from immediate postoperative time to 6 hours. The patients' immediate postoperative sedation scale less than 4 were significantly less in PNS group than GA group. The duration from surgery to discharge was shorter in PNS group than GA group. CONCLUSION: Regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block is a successful alternative to general anesthesia for clavicle surgery.
Analgesics ; Anesthesia, Conduction ; Anesthesia, General ; Brachial Plexus Block ; Brachial Plexus ; Cervical Plexus Block ; Cervical Plexus ; Clavicle ; Humans ; Peripheral Nerves ; Prospective Studies ; Visual Analog Scale ; Weights and Measures

Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery.
Anesthesia, Conduction ; Brachial Plexus ; Humans ; Nerve Block ; Pediatrics ; Pneumothorax ; Upper Extremity

BACKGROUND: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. METHODS: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. RESULTS: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. CONCLUSIONS: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety.
Anesthesia, Conduction ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Incidence ; Phrenic Nerve ; Shoulder ; Superficial Back Muscles ; Thoracic Nerves* ; Ultrasonography

BACKGROUND: Urinary retention is the most common complication after perianal surgery. The authors tried to evaluate the influence of the types and duration of the operation and the types of anesthesia on the incidence of urinary retention. METHODS: The medical and anesthetic records of 106 patients were reviewed retrospectively. They got perianal surgerys after recieving one of the regional blocks; 0.5% hyperbaric bupivacaine 5~8 mg intrathecally, 0.5% hyperbaric tetracaine 5~8 mg intrathecally, or 2% lidocaine 300 mg with epinephrine 5 g/ml caudally. The incidences of urinary retention were compared with each other by Chi-square test and Student t-test, according to the above mentioned points. RESULTS: Fifty percent of these patients underwent urinary catheterization. The incidence of urinary retention after hemorrhoidectomy (56.6%) was higher than that of other anorectal procedures (p<0.05, Chi-square test). The longer operating time was associated with urinary retention (p<0.05, Student t-test). The influence of local anesthetics (bupivacaine, tetracaine, and lidocaine) was absent (p>0.05, Chi-square test), but the difference between spinal and caudal anesthesia was slightly significant (p<0.05, Chi-square test), i.e. the incidence of urinary retention after caudal anesthesia was low. CONCLUSIONS: Short duration of operation, less traumatized perianal surgery, and caudal anesthesia are thought to lead to the lower incidence of urinary retention.
Anesthesia ; Anesthesia, Caudal ; Anesthesia, Conduction ; Anesthetics, Local ; Bupivacaine ; Epinephrine ; Hemorrhoidectomy ; Humans ; Incidence ; Lidocaine ; Retrospective Studies ; Tetracaine ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention*