British journal of anaesthesia
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Randomized Controlled Trial
Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial.
The inflammatory response to surgical tissue injury is associated with perioperative morbidity and mortality. We tested the primary hypotheses that major perioperative morbidity is reduced by three potential anti-inflammatory interventions: (i) low-dose dexamethasone, (ii) intensive intraoperative glucose control, and (iii) lighter anaesthesia. ⋯ Among our three interventions, dexamethasone alone reduced inflammation. However, no intervention reduced the risk of major morbidity or 1 yr mortality. TRIAL REGISTRATION IDENTIFIER: NCT00433251 at www.clinicaltrials.gov.
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Randomized Controlled Trial
Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery.
Emergence agitation is common after nasal surgery. We investigated the effects of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery in adult patients. ⋯ Intraoperative infusion of dexmedetomidine provided smooth and haemodynamically stable emergence. It also improved quality of recovery after nasal surgery.
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Randomized Controlled Trial
Ilioinguinal and iliohypogastric nerves cannot be selectively blocked by using ultrasound guidance: a volunteer study.
Ilioinguinal (IL) and iliohypogastric (IH) nerve blocks are used in patients with chronic postherniorrhaphy pain. The present study tested the hypothesis that our method, previously developed in cadavers, blocks the nerves separately and selectively in human volunteers. ⋯ The IL and IH nerves cannot be selectively blocked even if volumes below 1 ml are used. The most likely explanation is the spread of local anaesthetic from one nerve to the other, although this could not be directly observed in most cases.
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Randomized Controlled Trial
Local infiltration analgesia for total knee arthroplasty: should ketorolac be added?
Adequate postoperative analgesia with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee arthroplasty (TKA). High-volume local infiltration analgesia (LIA) with ropivacaine has been introduced, but effects of adjuvants are still debated. We tested the hypothesis that the addition of ketorolac to LIA significantly improves analgesia after TKA. ⋯ LIA with ketorolac results in reduced morphine consumption, reduced pain intensity, and earlier readiness for hospital discharge.
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Randomized Controlled Trial
Oral choline supplementation for postoperative pain.
Activation of nicotinic receptors with nicotine has been shown to reduce post-surgical pain in clinical and preclinical studies. Choline is a selective agonist at α7-type nicotinic receptors that does not have addictive or sympathetic activating properties. It is anti-nociceptive in animal studies. We conducted a double-blind randomized trial of oral choline supplementation with lecithin to aid in the treatment of pain after gynaecological surgery. ⋯ Oral supplementation with lecithin during the perioperative period resulted in very slow absorption and thus only a small increase in plasma choline was achieved. This concentration was inadequate to reduce TNF as has been shown in other studies. The absence of an anti-inflammatory effect was likely related to our failure to demonstrate efficacy in pain reduction.