Anaesthesia and intensive care
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Anaesth Intensive Care · May 2010
Randomized Controlled TrialEffect of gabapentin on pain after cardiac surgery: a randomised, double-blind, placebo-controlled trial.
This study evaluated whether perioperative administration of gabapentin in cardiac surgery patients could reduce postoperative opioid consumption, postoperative sleep or perceived quality of recovery. This randomised controlled trial assigned 60 patients undergoing cardiac surgery to receive 1200 mg of gabapentin or placebo two hours preoperatively, and then 600 mg of gabapentin or placebo twice a day for the next two postoperative days. Postoperative opioid use was measured by the amount of fentanyl used in the first 48 hours postoperatively. ⋯ Fentanyl use, visual analog pain scores, sleep scores, adjunctive pain medication use and number of anti-emetics given were not significantly different between the gabapentin and placebo groups. The incidence of side-effects was similar between the gabapentin and placebo groups, and no difference was found between groups in relation to quality of recovery. These findings indicate that preoperative use of gabapentin followed by postoperative dosing for two days did not significantly affect the postoperative pain, sleep, opioid consumption or patient-perceived quality of recovery for patients undergoing cardiac surgery.
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Anaesth Intensive Care · May 2010
Case ReportsContinuous tunnelled femoral nerve block for palliative care of a patient with metastatic osteosarcoma.
An 18-year-old man with metastatic femoral osteosarcoma had inadequate pain control with gabapentin, naproxen and intravenous fentanyl. A tunnelled femoral nerve catheter was used to administer a continuous infusion of 0.2% ropivacaine and 4 microg/ml clonidine (10 ml/hour) until his death 88 days later During discharge from hospital, catheter disconnection resulted in severe pain and readmission. Tunnelling, aseptic insertion technique, antibiotics and sterile infusate prepared by the pharmacy may have reduced the chance of infection. We propose that this is a suitable and effective technique in the long-term management of patients with terminal cancer and should be considered on a case-by-case basis.
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Anaesth Intensive Care · May 2010
Comparative StudyComparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block.
Transversus abdominis plane block provides postoperative analgesia following abdominal surgery by targeting thoracolumbar nerves between the internal oblique and transversus abdominis muscles. Posterior and subcostal approaches using ultrasound guidance have been described. However there have been inconsistent results in relation to the extent of the sensory block. ⋯ Median pain scores at rest and with coughing were 20 (interquartile range 10 to 35) and 50 (interquartile range 29 to 67) respectively at 24 hours. The posterior approach appears to be more appropriate for lower abdominal surgery and the subcostal approach better suited to upper abdominal surgery. Whichever approach is used, transversus abdominis plane block is only one component of a multimodal analgesic technique.
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Anaesth Intensive Care · May 2010
Randomized Controlled Trial Comparative StudyCaudal epidural block in children: comparison of needle insertion parallel with caudal canal versus conventional two-step technique.
This study compared the technique of inserting the needle for caudal epidural blockade in a single pass parallel to the caudal canal versus the conventional technique of approaching the caudal canal with the needle at a steeper angle. Seventy-five patients, aged 0 to 72 months, scheduled for urological surgery were prospectively enrolled in this study. Patients were randomly divided into two groups: a conventional method group (caudal block performed with conventional needle insertion, n=40) and a new method group (needle inserted into the skin at an angle of 200 and into the caudal space without redirection, n=35). ⋯ Subcutaneous placement of the needle after the first attempt occurred in two cases in the conventional method group and three cases in the new method group. Bloody tap occurred in four cases, all in the conventional method group and none in the new method group. When required, the second pass was successful in all cases.