Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 5 Articles
Objective: To compare P6 acupuncture plus ondansetron with either ondansetron\nor P6 acupuncture in the prevention of postoperative nausea and\nvomiting (PONV) in patients submitted to spinal anesthesia. Methods: A\nrandomized controlled trial was performed with 90 patients undergoing orthopedic\nsurgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and\nmorphine, 100 �¼g. They were assigned to one of the three groups: Group Ondansetron\n(n = 30), patients were given ondansetron, 8 mg intravenously, before\nspinal block was performed; Group P6 acupuncture (n = 30), patients\nwere subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes\nbefore anesthesia; and Group P6 acupuncture plus ondansetron (n = 30), the\nexact combination of the groups Ondansetron and P6 acupuncture. Results:\nIn the post anesthesia care unit, the incidence of nausea and vomiting ranged\nfrom 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant\ndifferences among groups (p > 0.05). Ondansetron group had the highest incidence\nof nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the\nward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and\nP6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion:\nPreoperative stimulation of P6 acupoint in combination with ondansetron has\nhigher efficacy than either P6 acupoint stimulation or the administration of ondansetron on the prevention of PONV in patients submitted to bupivacaine-\nmorphine spinal anesthesia....
Background: High post-operative pain scores after ââ?¬Å?minorââ?¬Â orthopedic/trauma surgery are in part attributed to\ninadequate prescription of opioid analgesics. Novel concepts aiming to achieve sufficient analgesia while minimizing\nopioid-related side effects by avoiding fluctuating plasma levels are based on perioperative oral administration of\nextended-release opioids beginning with the first dose pre-operatively. This is the first study to evaluate analgesic\nefficacy and side effect rates of extended-release tapentadol compared to oxycodone/naloxone following orthopedic/\ntrauma surgery.\nMethods: This randomized, observer-blinded, active-controlled prospective clinical trial had 2 co-primary endpoints: (1)\nAnalgesic efficacy: Mean pain level on a numeric rating scale (NRS) from 0 to 10 during exercise over 5 days. (2) Safety:\nSide effect sum score of the following events: Nausea, vomiting, constipation, sedation, vertigo, somnolence. The study\nwas powered to detect superiority of tapentadol for at least one endpoint pending statistical proof of non-inferiority\nfor both endpoints in a first step.\nResults: Two hundred sixty-six trauma patients were randomized to receive either tapentadol (n = 133) or oxycodone/\nnaloxone (n = 133). Analgesic efficacy: Mean (Ã?±SD) daily pain levels in the first five post-operative days were 2.8 Ã?± 1.3 in\nboth groups. Mean maximum pain intensity during exercise in the first 24 h after surgery was 3.8 Ã?± 1.9 (tapentadol) and\n3.8 Ã?± 2.1 (oxycodone/naloxone). Statistically tapentadol was non-inferior but not superior to oxycodone/naloxone.\nSafety: Vomiting on day 1 occurred in 11%, constipation in 35% of the tapentadol patients and in 16% and 30% of the\noxycodone/naloxone patients (p = 0.60 and 0.33), respectively. The incidence of sedation/ vertigo was <10%, that of\nsomnolence <2% in both groups (p > 0.3, respectively). The sum score of side effect events was 51% in the tapentadol\nvs. 49% in the oxycodone/naloxone group; risk difference 3% [95% CI, âË?â??8 to 14%]; p = 0.6). Non-inferiority of\ntapentadol could not be concluded as the pre-defined non-inferiority margin was exceeded.\nConclusions: With both concepts, mean maximum pain intensity during exercise within the first 24 h after orthopedic/\ntrauma surgery was reduced to a score of <4. This analgesic efficacy came at the cost of mainly gastro-intestinal side\neffects. Thus, we now use a prophylaxis against nausea and vomiting and pre-emptive laxatives as part of these\nconcepts....
We report a patient with severe pulmonary arterial hypertension (PAH) undergoing\ntibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement\nin the management of PAH, the risks of anesthesia, surgery, and\npostoperative morbidity and mortality still remain high. A 46-year-old female\nwas presented with severe PAH and end stage renal disease requiring hemodialysis\nthree times a week. Ultrasound-guided sciatic, femoral, and obturator\nnerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5\nml, respectively. All the blocks were successful, and the patient underwent\nuneventful anesthesia and surgery. In addition, the postoperative pain control\nlasted for 15 h and the patient was discharged on POD 5 without any complications.\nTherefore, ultrasound-guided sciatic, femoral, and obturator nerve\nblocks are valuable alternative to the general or neuraxial anesthesia in patients\nwith severe pulmonary hypertension....
Background: Acute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery.\nThis study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid\nadministration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs).\nMethods: Data from adult patients who underwent elective cardiac surgery between January 2002, and December 2013\nin a single center were analyzed. Propensity scores estimating the likelihood of receiving ITMA were used to match (1:1)\npatients with ITMA and patients with intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint\nincluding pneumonia, adult respiratory distress syndrome, and any type of acute respiratory failure. Secondary outcomes\nwere in-hospital mortality, cardiovascular complications, and length of stay in the intensive care unit (ICU) and hospital.\nResults: From a total of 1ââ?¬Â²543 patients, 920 were treated with ITMA and 623 with IVA. No adverse event consequent to\nthe spinal puncture was reported. Propensity score matching created 557 balanced pairs. The occurrence of PPCs in\npatients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 0.6; 95% CI, 0.40ââ?¬â??0.89; p = 0.012). Fewer patients\nwith ITMA had a prolonged stay in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 25.5% vs.\n31.8%. p = 0.024). In-hospital mortality and cardiovascular complications did not differ significantly between the two\ngroups.\nConclusion: In this study involving cardiac surgical patients, ITMA was safely applied and was associated with fewer\nPPCs...
Objectives. To evaluate the impact of volatile anesthetic choice on clinically relevant outcomes of patients undergoing cardiac\nsurgery. Methods. Major databases were systematically searched for randomized controlled trials (RCTs) comparing volatile\nanesthetics (isoflurane versus sevoflurane) in cardiac surgery. Study-level characteristics, intraoperative events, and postoperative\noutcomes were extracted from the articles. Results. Sixteen RCTs involving 961 patients were included in this meta-analysis. There\nwere no significant differences between both anesthetics in terms of intensive care unit length of stay (SMD âË?â??0.07, 95% CI âË?â??0.38 to\n0.24, ...
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