Anesthesia and analgesia
-
Anesthesia and analgesia · May 2013
Review Meta AnalysisPreventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs.
Barreveld et al. show that LA administered either IV or via block; before, during or after surgery, significantly reduces postoperative pain and opioid consumption.
Specifically in:
- Total knee arthroplasty (femoral, sciatic and lumbar plexus b., single-shot or continuous)
- Total hip arthroplasty (continuous lumbar plexus; intra-articular LA)
- Knee arthroscopy (single-shot lumbar plexus; IA LA; single-shot femoral nerve ± sciatic).
- Arthroscopic shoulder surgery - interscalene b., single-shot or continuous. IA is not beneficial.
- Hand & forearm surgery - axillary b. offers analgesic benefits only on day of surgery.
- TAP block is beneficial for laparoscopic, open appendectomy, abdominal surgery, cesarean section, and TAH.
-
Anesthesia and analgesia · May 2013
Randomized Controlled Trial Multicenter StudyNitrous oxide and serious morbidity and mortality in the POISE trial.
Nitrous oxide exposure was not associated with 30-day MI, stroke, death or hypotension in an observational analysis of POISE subjects.
pearl -
Anesthesia and analgesia · May 2013
Review Meta AnalysisRegional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis.
Meta-analysis suggests regional scalp block may reduce post-operative pain after craniotomy, although relies on small, low-quality studies.
pearl -
Anesthesia and analgesia · May 2013
Randomized Controlled Trial Comparative StudyA randomized comparison between bifurcation and prebifurcation subparaneural popliteal sciatic nerve blocks.
In this prospective, randomized, observer-blinded trial, we compared ultrasound-guided subparaneural popliteal sciatic nerve blocks performed either at or proximal to the neural bifurcation (B). We hypothesized that the total anesthesia-related time (sum of performance and onset times) would be decreased with the prebifurcation (PB) technique. ⋯ When local anesthetic is injected inside the paraneural sheath, B and PB posterior popliteal sciatic nerve blocks result in comparable success and total anesthesia-related times. However, in light of the 95% CIs, we cannot exclude the possibility that an intergroup difference of 19% and 7.83 minutes might have gone undetected for success rate and total time, respectively.
-
Anesthesia and analgesia · May 2013
Randomized Controlled TrialAn alternative distal approach for the lumbar medial branch radiofrequency denervation: a prospective randomized comparative study.
An alternative technique involving a "distal approach" can be used for lumbar medial branch radiofrequency denervation (LMBRFD). We described and assessed this technique by comparing it with a conventional tunnel vision approach in a prospective randomized trial. ⋯ Patients who underwent LMBRFD by the tunnel vision or distal approaches showed significant pain relief at the 6-month follow-up. Less periprocedural pain was reported in the distal approach group. We consider that the distal approach provides an improved option for LMBRFD.