Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 7 Articles
Background: The purpose of this study was to compare the effects of scalp nerve block (SNB) and local anesthetic\ninfiltration (LA) with 0.75% ropivacaine on postoperative inflammatory response, intraoperative hemodynamic\nresponse, and postoperative pain control in patients undergoing craniotomy.\nMethods: Fifty-seven patients were admitted for elective craniotomy for surgical clipping of a cerebral aneurysm.\nThey were randomly divided into three groups: Group S (SNB with 15 mL of 0.75% ropivacaine), group I (LA with 15\nmL of 0.75% ropivacaine) and group C (that only received routine intravenous analgesia). Pro-inflammatory cytokine\nlevels in plasma for 72 h postoperatively, hemodynamic response to skin incision, and postoperative pain intensity\nwere measured.\nResults: The SNB with 0.75% ropivacaine not only decreased IL-6 levels in plasma 6 h after craniotomy but also\ndecreased plasma CRP levels and increased plasma IL-10 levels 12 and 24 h after surgery compared to LA and\nroutine analgesia. There were significant increases in mean arterial pressure 2 and 5 mins after the incision and\nduring dura opening in Groups I and C compared with Group S. Group S had lower postoperative pain intensity,\nlonger duration before the first dose of oxycodone, less consumption of oxycodone and lower incidence of PONV\nthrough 48 h postoperatively than Groups I and C.\nConclusion: Preoperative SNB attenuated inflammatory response to craniotomy for cerebral aneurysms, blunted\nthe hemodynamic response to scalp incision, and controlled postoperative pain better than LA or routine analgesia....
Background: Ultrasound-guided for regional anesthesia offers many potential\nbenefits in the emergency setting. Analgesia can be explicitly targeted to\nthe region of pain and provide relief for many hours and decrease needing to\nthe large volume of local anesthetic. The aim of the work: Comparing the efficacy\nof dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular\nbrachial plexus blocks on the onset of sensory, motor blockade\nand postoperative analgesia. Patients and methods: This prospective, randomized,\nsingle-blind clinical study conducted on 60 patients underwent upper\nlimb surgery done by ultrasound-guided supraclavicular brachial plexus\nblock; these patients allocated into two equal groups: Group I (control) received\n20 ccs (19 cc bupivacaine 0.5% + 1 cc saline), Group II received 20 cc\n(19 cc bupivacaine 0.5% + 1 cc volume of Dexmedetomidine 1 ug/kg). Results:\nDemographic data and surgical characteristics were comparable in both\ngroups. The onset times for sensory and motor blocks were significantly\nshorter in Group II than Group I (P < 0.001), while the duration of blocks\nwas considerably longer (P < 0.001) in Group II. Except for the first recordings\n(at 0, 5, and 10 min), heart rate levels in Group II were significantly lower\n(P < 0.001). MBP levels in Group II at 15, 30, 45, 60, 90 and 120 min were\nsignificantly lower than in Group I (P < 0.001). The duration of analgesia\n(DOA) was significantly longer in Group II than Group I (P < 0.001). As regards\nto the visual Analouge score, there is a highly significant difference at 6\nhours, 8 hours and 10 hours in Group II than Group I. Conclusion: We\nrecommend adding Dexmedetomidine to local anesthetics in peripheral nerve\nblocks to take advantage of the prolonged time of both sensory and motor\nblocks and prolonged postoperative analgesia....
Background: To compare surgical field visibility between patients given propofol/remifentanil (PR) or desflurane/\nremifentanil (DR) anesthesia.\nMethods: A total of 80 adult patients undergoing middle ear microsurgery due to cholesteatoma otitis media with\nAmerican Society of Anesthesiologists physical status I and II were randomly assigned to the PR or DR groups. The\ndepth of anesthesia was titrated to maintain a Bispectral index (BIS) between 40 and 50. Remifentanil was titrated\nto maintain the mean blood pressure within........................
Background: Previous studies have demonstrated that dexmedetomidine improves the quality of postoperative\nanalgesia. In the present study, we performed a meta-analysis of randomized controlled trials to quantify the\neffect of dexmedetomidine as an adjuvant to sufentanil for postoperative patient-controlled analgesia (PCA).\nMethods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched for\nrandomized controlled trials in which dexmedetomidine was used as an adjuvant for PCA with sufentanil. In\nthe retrieved studies, we quantitatively analyzed pain intensity, sufentanil consumption, and drug-related side effects.\nResults: Nine studies with 907 patients were included in this meta-analysis. Compared with sufentanil alone,\ndexmedetomidine-sufentanil for postoperative intravenous PCA reduced pain intensity at 24 h (mean difference (MD)\n= - 0.70points; 95% confidence interval (CI): - 1.01, - 0.39; P < 0.00001) and 48 h postoperatively (MD = -0.61points; 95%\nCI: - 1.00, - 0.22; P = 0.002). Moreover, dexmedetomidine-sufentanil reduced sufentanil consumption during the first\n24 h (MD = -13.77 micro g; 95% CI: - 18.56, - 8.97; P < 0.00001) and 48 h postoperatively (MD = -20.81 micro g; 95% CI: - 28.20, -13.42; P < 0.00001). Finally, dexmedetomidine-sufentanil improved patient satisfaction without increasing the incidence\nof side effects.\nConclusions: Dexmedetomidine as an adjuvant to sufentanil for postoperative PCA can reduce postoperative pain\nscore and sufentanil consumption....
Abstract: Addressing the hypothesis that anaesthetic-analgesic technique during cancer surgery might influence recurrence or metastatic spread is a research priority. Propofol, which has anti-inflammatory properties in vitro, is clinically associated with reduced risk of cancer recurrence compared with sevoflurane anaesthesia in retrospective studies. Amide local anaesthetics, such as lidocaine, have cancer inhibiting effects in vitro. Steroids have anti-inflammatory and immunosuppressive effects and are associated with improved recovery after major non-cancer surgery. We compared the effects of propofol, lidocaine and methylprednisolone on postoperative metastasis in a murine model of breast cancer surgery under sevoflurane anaesthesia. 4T1 tumour cells were introduced into the mammary fat-pad of female BALB/c mice and the resulting tumour resected seven days later under general anaesthesia with sevoflurane....................
Background: Buprenorphine, a partial opioid agonist, displaces full opioid agonists from receptors and may\nimpede surgical pain management. We report the effects of a sublingual formulation of buprenorphine-naloxone,\nSuboxone (SL-BUP), on perioperative pain management.\nMethods: We identified all adult surgical patients from December 31, 2004, to January 1, 2016, who received SLBUP\nwithin 30 days prior to procedures performed with general, regional, or combined general/regional anesthesia.\nWe recorded opioid use during the procedure, in the post-anesthesia care unit (PACU), and during the 24 h\nfollowing PACU discharge. We also examined opioid use in those who continued SL-BUP until the day of surgery vs\nthose who preoperatively discontinued SL-BUP.\nResults: Thirty-two patients were treated preoperatively with SL-BUP. Three patients had regional anesthesia only,\nand opioid requirements were case dependent. Requirements were minimal for creation of an arteriovenous fistula\nand high following knee replacement and cesarean section. Twelve patients received combined general/regional\nanesthesia, and 17 received general anesthesia only. Intraoperative and PACU opioid use in these 2 groups were\nnot significantly different (P = .10 and P = .93, respectively). In both groups opioid use increased after discharge from\nthe PACU, and remained comparable between the general and combined general/regional group through the first\n24 h after PACU discharge (P = .78). Although median [interquartile range] 24-h opioid doses were higher among\npatients who discontinued SL-BUP, the difference was not statistically significant in the general anesthesia-only\ngroup (SL-BUP discontinued, 199 [110-411] mg IV-MEq [intravenous morphine equivalent] vs SL-BUP continued, 106\n[58-160] mg IV-MEq; P = .15) or in the combined general/regional group (SL-BUP discontinued, 140 [100-157] mg\nIV-MEq vs SL-BUP continued, 100 [73-203] mg IV-MEq; P = .94).\nConclusions: Regardless of the type of anesthesia used, physicians treating patients with SL-BUP must be prepared\nto administer large doses of opioids during the early postoperative period. No difference in opioid requirements\nwas noted between patients who perioperatively stopped SL-BUP versus those who continued SL-BUP....
Background: The ultrasound-guided proximal intercostal block (PICB) is performed at the proximal intercostal\nspace (ICS) between the internal intercostal membrane (IIM) and the endothoracic fascia/parietal pleura (EFPP)\ncomplex. Injectate spread may follow several routes and allow for multilevel trunk analgesia. The goal of this study\nwas to examine the anatomical spread of large-volume PICB injections and its relevance to breast surgery analgesia.\nMethods: Fifteen two-level PICBs were performed in ten soft-embalmed cadavers. Radiographic contrast mixed with\nmethylene blue was injected at the 2nd(15 ml) and 4th(25 ml) ICS, respectively. Fluoroscopy and dissection were\nperformed to examine the injectate spread. Additionally, the medical records of 12 patients who had PICB for breast\nsurgery were reviewed for documented dermatomal levels of clinical hypoesthesia. The records of twelve matched\npatients who had the same operations without PICB were reviewed to compare analgesia and opioid consumption.\nResults: Median contrast/dye spread was 4 (2-8) and 3 (2-5) vertebral segments by fluoroscopy and dissection\nrespectively. Dissection revealed injectate spread to the adjacent paravertebral space, T3 (60%) and T5 (27%), and\ncranio-caudal spread along the endothoracic fascia (80%). Clinically, the median documented area of hypoesthesia was\n5 (4-7) dermatomes with 100 and 92% of the injections covering adjacent T3 and T5 dermatomes, respectively. The\npatients with PICB had significantly lower perioperative opioid consumption and trend towards lower pain scores.\nConclusions: In this anatomical study, PICB at the 2nd and 4th ICS produced lateral spread along the corresponding\nintercostal space, medial spread to the adjacent paravertebral/epidural space and cranio-caudal spread along the\nendothoracic fascial plane. Clinically, combined PICBs at the same levels resulted in consistent segmental chest wall\nanalgesia and reduction in perioperative opioid consumption after breast surgery. The incomplete overlap between\nparavertebral spread in the anatomical study and area of hypoesthesia in our clinical findings, suggests that additional\nnon-paravertebral routes of injectate distribution, such as the endothoracic fascial plane, may play important clinical\nrole in the multi-level coverage provided by this block technique....
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