Minerva anestesiologica
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In this review, some of the newer developments in regional anaesthesia (RA) are discussed. The relationship between paraesthesiae and nerve stimulator responses has been shown to be unclear, and sometimes at a needle tip location where a paraesthesia is found, there is no response to the nerve stimulator. It is recommended to use whichever end point is found first. ⋯ The use of PCA for blocks as well as intravenously and the extension of the use of RA into the home are important developments. The beneficial effects of RA on postoperative morbidity and mortality are becoming clearer, and the introduction of the two new local anaesthetic agents, ropivacaine and levobupivacaine have improved safety. There has, however, been very slow progress in the development of long awaited ultralong acting local anaesthetics or in the introduction of slow release formulations.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Comparative Study Clinical Trial[S(-) bupivacaine (levobupivacaine) in peripheral blocks: preliminary results].
We have compared the onset time, anesthetic potency and adverse effects of three local anaesthetics (ropivacaine, levobupivacaine and bupivacaine) in two type of peripheral blocks (brachial plexus block for upper limb and femoral nerve block for lower limb) in adult patients in a double blind, randomized, prospective study. A total of 66 patients undergoing orthopaedic surgery were randomly allocated to receive brachial plexus block or femoral nerve blockade with 0,5% ropivacaine (group R, n=22), 0,5% levobupivacaine (group L, n=22) or 0,5% bupivacaine (group B, n=22), each groups has been divided into two subgroups (LBP n=11, RBP n=11, BPB n=11, LBF n=11, RBF n=11, BBF n=11) dipending on the type of block. The onset of sensory nerve block was similar for the three groups; the onset of motor block and onset time ready to surgery were faster in group R (-30%) if compared with group L and B. ⋯ We did not observe any adverse effect. We conclude that ropivacaine acts faster with less interpatient variability, while levobupivacaine and bupivacaine offer a prolonged postoperative analgesia. For this reason, with the exception of bupivacaine due to major cardio and neuro toxicity, we can indifferently use levobupivacaine or ropivacaine depending on the requested characteristics of the anesthetic.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Comparative Study Clinical TrialHypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery.
To evaluate the usefulness of hypertonic saline solutions (HTS) as an alternative to mannitol in neurosurgery. ⋯ HTS can safely be used in humans they obtain a reduction of ICP without reducing CVP, serum osmolality and Na+ serum values. Our data underline the possibility of their use as an alternative to mannitol in the treatment of patients scheduled for intracranial surgery, especially when multiple doses are needed.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Clinical TrialKetorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery.
This study aims to assess the best postoperative analgesia during maxillofacial surgery by using small doses of ketorolac or tramadol or their association and evaluates the presence of adverse effects due to NSAID or opioid use. ⋯ Ketorolac and Tramadol produced comparable, effective and low cost postoperative analgesia during maxillofacial surgery. There are only statistically significant differences considering side effects.
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Ropivacaine is a relatively new long-acting local anesthetic. It is a pure S(-) isomer, with a high pKa and low lipid solubility. Because of its physical and chemical properties, ropivacaine produces a marked differential in sensory and motor blockades, with a toxic potential lower than other long-acting anesthetic solutions. The purpose of this paper was the evaluation of the literature concerning indications and advantages of ropivacaine for different regional anesthesia techniques. ⋯ Ropivacaine is a long-acting local anesthetic with a marked differential blockade between sensory and motor fibres, overall at the low concentrations used for postoperative analgesia. It probably has a slightly lower potency as compared with bupivacaine, but provides similar clinical efficacy in the different fields of regional anesthesia. Ropivacaine is less cardiotoxic and causes less central nervous system toxicity than bupivacaine, and this lower toxic potential has been reported not only with equivalent but also with equipotent concentrations and doses. For this reason, ropivacaine represents a useful alternative to bupivacaine for central and peripheral nerve blocks as well as for the management of postoperative pain relief.