Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialA transdermal nicotine patch is not effective for postoperative pain management in smokers: a pilot dose-ranging study.
Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we examined the postoperative analgesic effect of a transdermal nicotine patch in smokers in a parallel design to a previous study in nonsmokers. ⋯ Transdermal nicotine, 5-15 mg, failed to relieve postoperative pain or reduce opioid use in smokers.
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Anesthesia and analgesia · Dec 2009
ReviewRadial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations.
Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. ⋯ Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialSystemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery.
In this randomized, blinded, placebo-controlled trial, we evaluated whether systemic lidocaine would reduce pain and time to discharge in ambulatory surgery patients. ⋯ Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialThe early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study.
Ketamine has been shown to have a morphine-sparing effect soon after surgery. Nevertheless, whether this effect still exists after being combined with nonsteroidal antiinflammatory drugs and acetaminophen, and whether ketamine can decrease chronic pain after nononcologic surgery remain unclear. Thus, we designed a study to assess ketamine's effect on acute and chronic postoperative pain when combined with multimodal analgesia after total hip arthroplasty (THA). ⋯ Ketamine had a morphine-sparing effect after THA, even when morphine was combined with multimodal systemic analgesia. It also facilitated rehabilitation at 1 mo and decreased postoperative chronic pain up to 6 mo after surgery.
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Anesthesia and analgesia · Dec 2009
Clinical TrialUltrasound-assisted and evoked motor response stimulation of the deep peroneal nerve.
We performed an observational volunteer study to document an ultrasound-guided evoked motor response blockade of the deep peroneal nerve. ⋯ Visualization of the deep peroneal nerve with ultrasound followed by elicitation of an evoked motor response, or paresthesia, predicts successful blockade of the deep peroneal nerve.