Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2009
Randomized Controlled TrialAdding gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty.
Gabapentin (GPN) is effective in reducing post-operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre-operative administration of gabapentin is more effective than post-operative administration. ⋯ A single 600 mg dose of gabapentin given pre-operatively or post-operatively does not reduce morphine consumption or pain scores in hospital or at 6 months after hip arthroplasty within the context of spinal anesthesia and a robust multimodal analgesia regimen.
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Acta Anaesthesiol Scand · Sep 2009
Randomized Controlled TrialThe addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia.
Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post-operative epidural analgesia in children. ⋯ The addition of 0.2 mcg/kg/h fentanyl to 1.5 mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.
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Acta Anaesthesiol Scand · Sep 2009
Anaesthetic requirement and stress hormone responses in patients undergoing lumbar spine surgery: anterior vs. posterior approach.
The intensity of nociceptive stimuli reflects the severity of tissue injury. The anaesthetic requirement and stress hormonal responses were determined to learn whether they differ according to different surgical approaches (anterior vs. posterior) during the spinal surgery. ⋯ The anterior approach required a deeper level of anaesthesia while undergoing spinal surgery and more use of post-operative analgesics than the posterior approach. It was also associated with a more pronounced AVP release during the surgery.
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Photoplethysmography (PPG), i.e. pulse oximetric wave, is a non-invasive technique that is used in anaesthesia monitoring primarily to monitor blood oxygenation. The PPG waveform resembles that of the arterial blood pressure but instead of pressure it is related to the volume changes in the measurement site and hence contains information related to the peripheral blood circulation, including skin vasomotion, which is controlled by the sympathetic nervous system. ⋯ In many of the published studies, PPG waveform information has been included. The focus of this topical review is to provide an overview on the information embedded in the PPG waveform especially in the context of the autonomic nervous system and analgesia monitoring.