Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2015
Randomized Controlled Trial Comparative StudyComparison of conventional infrainguinal versus modified proximal suprainguinal approach of Fascia Iliaca Compartment Block for postoperative analgesia in Total Hip Arthroplasty. A prospective randomized study.
Fascia Iliaca Compartment Block (FICB) has been widely used as a postoperative analgesic adjunct to opioids for total hip arthroplasty (THA), either by the conventional infrainguinal approach or the modified proximal suprainguinal approach irrespective of any specific advantage of one over the other. This study was conducted to compare the analgesic efficacy of the two techniques of FICB for postoperative analgesia. The 40 patients scheduled for THA were recruited for Intervention (s) and randomized to receive FICB either by suprainguinal approach (group S) or infrainguinal approach (group I) for postoperative analgesia with 40 ml of 0.2% bupivacaine, in addition to postoperative patient controlled analgesia (PCA) with morphine. ⋯ Postoperatively, there was significant difference in time to first PCA morphine demand (356.28 ± 33.32 vs 291.48 ± 37.17, p = < 0.001, respectively) in-group S vs. group I. The postoperative morphine consumption was also significantly less in group S compared to group I at 6, 12 and 24 hours and the cumulative morphine consumption in 24 hours (6.95 ± 2.14 vs 10.50 ± 2.24, p = < 0.001 respectively) was also less. In conclusion, in THA, suprainguinal approach of FICB has a superior postoperative analgesic efficacy compared to infrainguinal approach of FICB along with significantly less morphine consumption in first 24 hours.
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Acta Anaesthesiol Belg · Jan 2015
ReviewClinical evidence for dorsal root ganglion stimulation in the treatment of chronic neuropathic pain. A review.
Treating chronic neuropathic pain remains a challenge, despite the existing therapies. Recent years have seen the emergence of promising new technologies, such as the neurostimulation of the dorsal root ganglion (DRG). ⋯ To improve the level of proof, larger randomized controlled trials are needed. These should include well-described populations, a sufficiently long follow-up and a detailed description of concurrent treatments (pharmacologic and patient integration in a multidisciplinary approach).
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Acta Anaesthesiol Belg · Jan 2015
Cerebral tissue oxygen saturation during arthroscopic shoulder surgery in the beach chair and lateral decubitus position.
Arthroscopic shoulder surgery is a common procedure and can be performed with the patient in the lateral decubitus position (LDP) or beach chair position (BCP). Although the BCP is associated with better visualization and less bleeding, it has also been associated with hemodynamic changes and consequently cerebral hypoperfusion. Devastating events reported after surgery in the BCP were attributed to a combination of the upright position and hypotension. ⋯ Near infrared spectroscopy might be able to provide an early warning sign of cerebral hypoperfusion during shoulder surgery in the BCP. It was therefore recommended to continuously monitor cerebral oxygenation in patients undergoing shoulder surgery in the BCP, to potentially prevent devastating outcomes. However, more clinical research on the safe lower limits of cerebral tissue oxygen saturation is needed for this recommendation to gain broad acceptance.
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Acta Anaesthesiol Belg · Jan 2015
Randomized Controlled Trial Comparative StudyA comparative evaluation of the Airtraq and King Vision video laryngoscope as an intubating aid in adult patients.
Airtraq has been shown to improve ease of intubation in patients with normal and difficult airway. King Vision video laryngoscope is a newly introduced intubating device with an attached monitor. We here hypothesized that the King Vision video laryngoscope with channeled blade performs better during intubation as compared to Airtraq. ⋯ The time required to intubate patients was significantly shorter when the King Vision video laryngoscope with channeled blade was used as compared to the Airtraq (p < 0.05). The number of attempts to successfully intubate patients was also significantly lower (p < 0.05) for the King Vision video laryngoscope than for the Airtraq. The use of the Kings Vision video laryngoscope with channeled blade should be encouraged in difficult intubation situations in adult patients with a mouth opening of more than 18 mm.
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Acta Anaesthesiol Belg · Jan 2015
Case ReportsA novel method of intubation and orogastric tube insertion using a C-MAC-D-blade videolaryngoscope-bougie technique.
Expertise in airway management is a fundamental aspect of anesthesia practice. Fortunately 'can't intubate, can't ventilate' scenarios are extremely rare. In particular, patients with tumors on the right side of the oropharynx and larynx can be very problematic to intubate. ⋯ The C-MAC D-Blade videolaryngoscope-bougie technique provides an alternative method to intubate patients with difficult airways, even in exceptional situations such as in patients with a large right-sided oropharynx-larynx tumor.