Journal of anesthesia
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Journal of anesthesia · Jun 2018
Meta Analysis Comparative StudyThe role of sciatic nerve block to complement femoral nerve block in total knee arthroplasty: a meta-analysis of randomized controlled trials.
Femoral nerve block (FNB) appears to have higher postoperative analgesic benefits compared with the patient-controlled analgesia (PCA) in total knee arthroplasty (TKA). However, the role of sciatic nerve block (SNB) as a complement to FNB remains controversial. We performed a meta-analysis assessing the benefits of the SNB as a complement to FNB, as well as comparing the efficacy of single-injection versus continuous SNB in TKA. ⋯ This meta-analysis provides evidence-based supports to the benefits of SNB as a complement to FNB in TKA. The combination sciatic-femoral nerve block appears to be the optimal choice for patients in high risk of postoperative opioids consumption or acute pain after TKA.
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Journal of anesthesia · Jun 2018
Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study.
This study was performed to assess the impact of age of ≥ 90 years on predicting postoperative complications. We retrospectively identified all patients aged ≥ 65 years who underwent surgical repair of hip fractures over a 4.5-year period in our hospital. In total, 261 patients were identified (mean age, 86.2 ± 6.8 years). ⋯ After propensity adjustment for these characteristics, postoperative complication rates in the oldest-old group remained significantly higher than those in the matched control group (odds ratio (OR) 2.76, 95% confidence interval (95% CI) 1.24-6.49; P = 0.011). Major complications also developed more frequently in the oldest-old group than control group (OR 9.78, 95% CI 1.31-4.36; P = 0.018). Anesthesiologists and surgeons should pay attention to potential complications following hip fracture surgery for patients aged ≥ 90 years regardless of American Society of Anesthesiologists class or social dependency.
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Journal of anesthesia · Jun 2018
Comparative StudyAccuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery.
The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CIFT) with that measured by three-dimensional echocardiography (CI3D). ⋯ The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit.
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Journal of anesthesia · Jun 2018
Randomized Controlled TrialLocal infiltration analgesia combined with a standardized multimodal approach including an adductor canal block in total knee arthroplasty: a prospective randomized, placebo-controlled, double-blinded clinical trial.
Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. This study evaluates the technique of local infiltration analgesia (LIA), by comparing it to saline injections in addition to a standardized multimodal regimen including an adductor canal block. ⋯ Performing LIA in addition to a standardized multimodal analgesia regimen results in superior pain control, demonstrated as reduced opioid needs and lower resting and dynamic pain intensity scores on the first postoperative day after TKA. Further studies are needed to establish an LIA protocol that could maximize postoperative pain control.
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Journal of anesthesia · Jun 2018
Review Practice GuidelineExecutive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians.
Neuropathic pain has a substantial effect on quality of life (QOL). The Japanese Society of Pain Clinicians (JSPC) has developed clinical guidelines of pharmacotherapy for neuropathic pain. These guidelines offer clarity on recommendations based on both the most recent scientific evidence and expert opinions. ⋯ When prescribing opioid analgesics, proposed as the third-line drugs, for neuropathic pain, the guidelines recommend physicians continue evaluations on either abuse or addiction. The guidelines do not recommend concomitant use of nonsteroidal anti-inflammatory drugs and acetaminophen because of lack of clinical evidence of their efficacy. If patients do not respond well to pharmacotherapy, which is prescribed in a step-wise manner, other treatment strategies should be considered to improve patients' activities of daily living and QOL.