European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia.
To investigate the interactions of postoperative pain and endocrine stress response, three groups of 21 patients each with total knee arthroplasty were compared in a randomized, prospective design. For postoperative pain management, a three-in-one block, an epidural catheter analgesia or an intravenous patient-controlled analgesia was used. ⋯ All methods of pain management led to sufficient analgesia, but they were not accompanied by an adequate reduction in endocrine stress response. Thus, postoperative pain is only a secondary stressor and sufficient analgesia with subjective well-being does not prove a stress-free state. With regard to the reduction of sympathoadrenergic stress response, epidural anaesthesia is superior to the three-in-one block and patient-controlled analgesia. Epidural anaesthesia is recommended particularly for high-risk patients with hypertension, coronary heart disease and diabetes mellitus. In these patients, the reduction of a 'hidden' endocrine stress response in addition to prevention of pain is of special interest.
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Cardiac arrest is a dramatic condition leading to sudden death if someone cannot perform two interventions, basic life support and early defibrillation, that have been proved to improve long-term survival. The modern era of cardiopulmonary resuscitation began with a description of closed chest cardiac massage by Kouwenhoven in 1960. Research to make advances in cardiac arrest is a very difficult task. ⋯ The links in the adult chain of survival are: early access; early CPR; early defibrillation; and early acute cardiac life support. The 'Utstein style', recently introduced, represents a standard of practice both inside and outside hospital with recommended guidelines for the uniform reporting of clinical data from the patient suffering cardiac arrest. According to the concept of the chain of survival, the Utstein style delineates time and establishes a set of core and supplemental times to be recorded that provide important characteristics of the response of victims of cardiac arrest.
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A new posterior approach to the sciatic nerve in the subgluteal region was developed. We describe our clinical experiences on 135 consecutive patients. ⋯ The study demonstrated that the sciatic nerve can be easily blocked using this new posterior subgluteal approach, suggesting that it represents a safe and effective alternative to block the sciatic nerve at a proximal level, with the potential for reducing the discomfort experienced by the patient during block placement.