Medicina
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Randomized Controlled Trial Comparative Study
[Postoperative analgesia with intraarticular local anesthetic bupivacaine and alpha2-agonist clonidine after arthroscopic knee surgery].
To evaluate the efficacy of intraarticular 0.5% 20 ml bupivacaine and compound of bupivacaine with alpha2-agonist clonidine for postoperative analgesia after arthroscopic knee surgery. A total of 48 patients, scheduled for knee arthroscopy, were enrolled in the study. Patients were randomly assigned to three different groups: placebo (group C), and two experimental groups that received one of the following double-blinded intraarticular solutions: 0.5% 20 ml of bupivacaine (group B) and 0.5% 20 ml of bupivacaine with l microg/kg of clonidine (group B+C). Patients were asked to evaluate on a visual analogy scale (VAS) the intensity of pain at rest and during motion, satisfaction with postoperative analgesia. Side effects and requirements for supplemental analgetics were recorded at the same time. ⋯ The compound of intraarticular bupivacaine and clonidine suppresses pain better than intraarticular injection of bupivacaine or use of usual systemic analgetics (p<0.05). Intraarticular analgesia assures satisfaction with anesthesiologic procedure.
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Randomized Controlled Trial Comparative Study
[Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study].
The aim of the study was to find minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery. ⋯ Groups were comparable in demographics. No case of failure was registered but 4 patients (10.5%) in the group 3 received supplemental i/v fentanyl to treat tension in the abdomen intraoperatively. Level of sensory block in groups 1, 2, 3 was 10.4+/-1.7, 7.013+/-2.2, 6.7+/-1.9 dermatomes, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=1.0 group 2 vs 3, Bonferroni). Extent of motor block was 2-3 scores according to the Bromage scale in 70.5% of group 1 cases, compared to 0-1 score in 97.3% of group 2 and 92.1% of group 3 cases. Median (range) duration of motor block in groups 1, 2, 3 was 90 (0-120), 0 (0-90), and 0 (0-60) min, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=0.13 group 2 vs 3, Bonferroni). Time of ambulation was 181.5+/-41.5, 136.6+/-32.2 and 123.0+/-45.9 min, respectively (p<0.0001 ANOVA; p<0.001 group 1 vs 2, p<0.00001 group 1 vs 3, p=0.43 group 2 vs 3, Bonferroni). There was no significant intergroup difference in time to urinate; retention developed in 20.4% of total cases. No difference was found in morphine consumption, 64.5% of cases did not require rescue analgesics. Quality of anesthesia was stated as excellent by the anesthesiologist and surgeon in all groups. However, quality was rated as excellent by patient in the operating room in groups 1, 2, 3: 58.8, 94.7, and 86.8%, respectively (p=0.003), on day 1 postoperatively: 76.5, 92.1, and 97.4%, respectively (p=0.023); by nursing staff: 82.4, 100, and 97.4%, respectively (p=0.019). Lower rates in group 1 were due to extensive motor block. In conclusion, a minimal recommended dose of spinal hyperbaric bupivacaine for anorectal surgery is 4-5 mg; a dose of 7.5 mg is excessive due to prolonged sensory and motor block.