Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2011
Randomized Controlled Trial Comparative StudyThe effect of neuraxial versus general anesthesia techniques on postoperative quality of recovery and analgesia after abdominal hysterectomy: a prospective, randomized, controlled trial.
Patients undergoing abdominal hysterectomy often have significant postoperative pain despite the use of concurrent multimodal pain strategies. Neuraxial anesthesia has opioid-sparing effects and may provide better postoperative recovery to patients when compared with general anesthesia. Our main objective in this study was to compare the effects of neuraxial and general anesthesia on postoperative quality of recovery after abdominal hysterectomy. ⋯ Neuraxial anesthesia provides better quality of recovery than does general anesthesia for patients undergoing abdominal hysterectomy. The opioid-sparing effects of neuraxial anesthesia were associated with a better quality of recovery in patients after the surgical procedure. In the absence of contraindications, neuraxial anesthesia seems to be a better anesthetic plan for those patients.
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Anesthesia and analgesia · Dec 2011
Randomized Controlled Trial Comparative StudyDistal tourniquet or leg position after injection enhances the efficacy of sciatic nerve blockade by the popliteal approach.
In this study, we hypothesized that leg positioning and distal tourniquet application, when compared with neutral positioning of the leg, alters the efficacy of sciatic nerve block performed by the double-stimulation technique. ⋯ Similar beneficial effects might be reached with the application of a distal tourniquet during injection or elevating the patient's leg turned supine immediately after sciatic nerve block with a popliteal approach by a double-injection technique. We suggest that using the leg-up position or application of a distal tourniquet for sciatic nerve block may lead to a more proximal distribution of the local anesthetic and may result in a faster onset of sensory and motor blocks as well as longer duration of blockade.
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Anesthesia and analgesia · Dec 2011
Randomized Controlled Trial Comparative StudyDoes the cerebral state index separate consciousness from unconsciousness?
The Cerebral State Monitor™ (CSM) is an electroencephalogram (EEG)-based monitor that is claimed to measure the depth of hypnosis during general anesthesia. We calculated the prediction probability (P(K)) for its ability to separate consciousness from unconsciousness in surgical patients with different anesthetic regimens. ⋯ The ability of CSM for separation of consciousness and unconsciousness was comparable to other commercially available EEG-based indices.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyIntraperitoneal ropivacaine nebulization for pain management after laparoscopic cholecystectomy: a comparison with intraperitoneal instillation.
Studies evaluating intraperitoneal local anesthetic instillation for pain relief after laparoscopic procedures have reported conflicting results. In this randomized, double-blind study we assessed the effects of intraperitoneal local anesthetic nebulization on pain relief after laparoscopic cholecystectomy. ⋯ Intraperitoneal ropivacaine nebulization was associated with reduced shoulder pain and unassisted walking time but with an increased incidence of postoperative vomiting after laparoscopic cholecystectomy.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled TrialA dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy.
Postoperative pain can delay functional recovery after outpatient surgery. Multimodal analgesia can improve pain and possibly improve quality of recovery. In this study, we evaluated the dose-dependent effects of a preoperative transversus abdominis plane (TAP) block on patient recovery using the Quality of Recovery 40 (QoR-40) questionnaire after ambulatory gynecological laparoscopic surgery. Global QoR-40 scores range from 40 to 200, representing very poor to outstanding quality of recovery, respectively. ⋯ The TAP block is an effective adjunct in a multimodal analgesic strategy for ambulatory laparoscopic procedures. TAP blocks with ropivacaine 0.25% and 0.5% reduced pain, decreased opioid consumption, and provided earlier discharge readiness that was associated with better quality of recovery.