Anesthesia and analgesia
-
Anesthesia and analgesia · Sep 2006
Randomized Controlled TrialValdecoxib for postoperative pain management after cesarean delivery: a randomized, double-blind, placebo-controlled study.
Although nonsteroidal antiinflammatory drugs (NSAIDs) improve postoperative pain relief after cesarean delivery, they carry potential side effects (e.g., bleeding). Perioperative cyclooxygenase (COX)-2 inhibitors show similar analgesic efficacy to nonsteroidal antiinflammatory drugs in many surgical models but have not been studied after cesarean delivery. We designed this randomized double-blind study to determine the analgesic efficacy and opioid-sparing effects of valdecoxib after cesarean delivery. ⋯ There were also no differences in IV morphine requirements, time to first analgesic request, patient satisfaction, side effects, breast-feeding success, or functional activity. Postoperative pain was generally well controlled. Adding valdecoxib after cesarean delivery under spinal anesthesia with intrathecal morphine is not supported at this time.
-
Anesthesia and analgesia · Sep 2006
Randomized Controlled TrialThe pharmacodynamics of ropivacaine and bupivacaine in combined sciatic and femoral nerve blocks for total knee arthroplasty.
The potency of ropivacaine compared with bupivacaine in regional anesthesia remains controversial. Therefore, we compared the pharmacodynamics of equal concentrations of bupivacaine and ropivacaine in combined sciatic and femoral nerve blocks for patients undergoing knee arthroplasty. Fifty patients received 40 mL of either 0.5% bupivacaine (n = 25) or 0.5% ropivacaine (n = 25) divided between the sciatic (15 mL) and the femoral (25 mL) nerves before induction of anesthesia. ⋯ Overall, pain scores and morphine consumption were similar. In conclusion, we showed that block resolution is different between bupivacaine and ropivacaine when administered for combined sciatic and femoral nerve blocks. A new systematic method to assess sciatic and femoral nerve blockade is proposed.
-
Anesthesia and analgesia · Sep 2006
Randomized Controlled TrialHypercapnia improves tissue oxygenation in morbidly obese surgical patients.
Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean patients but has not been evaluated in obese patients. ⋯ Demographic characteristics, cardiovascular measurements, and Pao2 (222 +/- 48 versus 230 +/- 68 mm Hg in normocapnic versus hypercapnic; mean +/- sd; P = 0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78 +/- 31 versus 56 +/- 13 mm Hg; P = 0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients.
-
Anesthesia and analgesia · Sep 2006
Randomized Controlled Trial Comparative StudyLarge-dose propofol during cardiopulmonary bypass decreases biochemical markers of myocardial injury in coronary surgery patients: a comparison with isoflurane.
We investigated if increasing propofol's dosage to augment its antioxidant capacity during cardiopulmonary bypass (CPB) could confer cardiac protection. Fifty-four coronary artery bypass graft surgery patients were randomly assigned to small-dose propofol (Group P; n = 18), large-dose propofol (Group HiP; n = 18), or isoflurane Group (Group I; n = 18). After the induction, anesthesia was maintained with an inspired concentration of isoflurane 1%-3.5% (Group I) or a continuous infusion of propofol 60 microg x kg(-1) x min(-1) (Group P) throughout the surgery. ⋯ Mean cardiac index was significantly higher at 24 h after CPB in Group HiP compared with Group P and Group I (P < 0.05) (Group I, 2.2 +/- 0.1; Group P, 2.3 +/- 0.2; and Group HiP, 2.8 +/- 0.3 L x min(-1) x m(-2), respectively). The duration of intensive care unit stay was significantly shorter in Group Hi-P compared with Group I. We conclude that administration of a large dose of propofol during CPB attenuates postoperative myocardial cellular damage as compared with isoflurane or small-dose propofol anesthesia.
-
Anesthesia and analgesia · Sep 2006
Randomized Controlled TrialNerve localization techniques for interscalene brachial plexus blockade: a prospective, randomized comparison of mechanical paresthesia versus electrical stimulation.
Postoperative neurologic symptoms (PONS) are relatively common after upper extremity orthopedic surgery performed under peripheral neural blockade. In this study, we prospectively compared the incidence of PONS after shoulder surgery under interscalene (IS) block using the electrical stimulation (ES) or mechanical paresthesia (MP) techniques of nerve localization. For patients randomized to the MP group, a 1-in, 23-g long-beveled needle was placed into the IS groove to elicit a paresthesia to the shoulder, arm, elbow, wrist, or hand. ⋯ The PONS lasted a median duration of 2 mo, and symptoms in all patients resolved within 12 mo. The success rate, onset time, and patient satisfaction were also comparable between groups. We conclude that the choice of nerve localization technique can be made based on the patient's and anesthesiologist's comfort and preferences and not on concern for the development of PONS.