Anesthesia, essays and researches
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Effective management of postoperative pain leads to increased patient satisfaction, earlier mobilization, reduced hospital stay and costs. One of the methods used for management of postoperative pain is preemptive analgesia-blockade of afferent nerve fibers before a painful stimulus. It modifies peripheral and central nervous system processing of noxious stimuli and reduces postoperative opioid consumption. In this study, we sought to determine whether the preoperative use of pregabalin reduced postoperative pain and morphine consumption in thyroidectomy. ⋯ Single oral dose of pregabalin was effective in reducing acute postoperative pain in thyroidectomy patients. It prolongs the time to the request of rescue analgesia and also results in lower postoperative pain scores in the immediate postoperative period. However a statistically significant low opioid consumption could not be proved.
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Intrathecal clonidine or dexmedetomidine has improved the quality of spinal anesthesia, this clinical study was undertaken to assess the behavior of intrathecal clonidine as an adjuvant to bupivacaine in augmenting sensory block in patients undergoing lower limb surgeries. ⋯ Supplementation of bupivacaine spinal block with a low dose of intrathecal dexmedetomidine (5 μg) or clonidine (50 μg) produces a significantly shorter onset of motor and sensory block and a significantly longer sensory and motor block than bupivacaine alone.
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The addition of fentanyl to ropivacaine has shown to improve the quality of analgesia without compromising its benefits such as early mobilization and early voiding. ⋯ The addition of fentanyl to ropivacaine significantly prolongs the duration of postoperative analgesia with clinically insignificant influence on hemodynamics and motor blockade with minimal side effects.
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Regional anesthesia is favored in patients who undergo emergency extremity (limb) surgery, and specifically so in the absence of fasting status. In the absence of ultrasonic guidance, the nerve stimulator still remains a valuable tool in performing a brachial block, but its use is difficult in an emergency surgical patient and greater cautious approach is essential. We identified the supraclavicular plexus by the nerve stimulation-motor response technique as follows. ⋯ The series of patients had difficulty for administering both general and regional anesthesia and we considered them as complex scenarios. The risk of the block failure was weighed heavily against the benefits of its success. The described series includes patients who had successful outcomes in the end and the techniques, merits, and risks are highlighted.
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Caudal-epidural bupivacaine versus ropivacaine with fentanyl for paediatric postoperative analgesia.
Caudal-epidural, the most commonly used regional analgesia technique, is virtually free of measurable hemodynamic effects, thus adding a new dimension to the evolving necessity of pediatric postoperative pain management. Though, bupivacaine is the most commonly used drug for this purpose, ropivacaine has emerged as a safer alternative, with the addition of opioids, like fentanyl, increasing the effective duration of analgesia. With this overview, our present study was designed to compare the postoperative analgesic efficacy of bupivacaine-fentanyl and ropivacaine-fentanyl combinations by caudal-epidural technique in pediatric infraumbilical surgeries. ⋯ Ropivacaine, with an equipotent analgesic efficacy and a lesser duration of motor block, can be used as an alternative to bupivacaine for pediatric postoperative pain care through the caudal route.