Current opinion in anaesthesiology
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Recently there has been a considerable increase in interest in regional anesthesia and neural blockade. Many traditional nerve block techniques have been significantly modified to better fit the realm of both inpatient and outpatient surgery. ⋯ A significant effort has also been invested in studying and improving the safety of various techniques. These developments, coupled with an increased emphasis on teaching of regional blocks by organized anesthesia societies are likely to result in a wider use of these techniques in years to come.
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The debate continues as to whether regional anesthesia is safer than general anesthesia. However, the choice of anesthetic technique is a complex decision. This review of the most recent publications compares the safety of regional anesthesia with that of general anesthesia.
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Since the first report of alpha2-adrenoceptor agonists, the list of clinical indications for this class of drugs continues to expand. Alpha2-adrenoceptor agonists have several beneficial actions during the perioperative period. ⋯ Furthermore, alpha2-adrenoceptor agonists may offer benefits in the prophylaxis and treatment of perioperative myocardial ischaemia and their role in pain management and regional anaesthesia is increasing. The development of new, highly selective compounds which not only reduce anaesthetic requirements but induce anaesthesia by themselves may provide a new concept for the administration of anaesthesia.
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Tramadol is a unique analgesic offering moderate, dose-related pain relief through its action at multiple sites. In contrast to pure opioid agonists, it has a low risk of respiratory depression, tolerance and dependence. ⋯ It may have advantages in paediatric and day-case surgery and as an adjunct in local anaesthetic techniques. This review provides an evidence-based account of the role of tramadol in modern practice.