Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial
Intraperitoneal sub-diaphragmatic instillation of bupivacaine plus morphine for reducing postoperative shoulder pain after gynecologic endoscopy.
Gynecologic endoscopic surgery is a minimally invasive surgical technique for treatment of various gynecologic diseases. When compared to conventional laparotomy, this procedure has advantages in many aspects such as reduced postoperative pain, short hospital stay, and decreased morbidity associated with laparotomy. However 15 to 30% of the patients experienced moderate or severe postoperative shoulder pain. Methods to minimize postoperative shoulder pain after gynecologic endoscopy are essential to maximize the quality of life of the patients. ⋯ Intraperitoneal instillation of bupivacaine plus morphine had no efficiency for reducing postoperative shoulder pain incidence after gynecologic endoscopy.
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Randomized Controlled Trial Comparative Study
A comparison of dexmedetomidine and propofol in Patients undergoing electrophysiology study.
Dexmedetomidine provides profound levels of sedation without affecting cardiovascular and respiratory stability based on its pharmacological profile. It may be a valuable sedative for procedures with minimal to mild pain. Electrophysiology study (EP study) is a mildly painful procedure that requires conscious sedation. The authors hypothesized that dexmedetomidine would cause lower respiratory and cardiovascular depression than propofol during equal sedation level in an electrophysiology study. ⋯ The present study demonstrated that comparable sedation could be achieved by a combination of pethidine with either dexmedetomidine or propofol during EP study. Dexmedetomidine group provided more hemodynamic and respiratory stability than propofol group.
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Randomized Controlled Trial
Periarticular infiltration of 0.25% bupivacaine on top of femoral nerve block and intrathecal morphine improves quality of pain control after total knee arthroplasty: a randomized double-blind placebo controlled clinical trial.
Find out if the addition of periarticular local anesthetic infiltration enhances the quality of postoperative pain control in patients with knee arthroplasty (TKA) in spinal anesthesia and intrathecal morphine plus single shot femoral nerve block (FNB). MATERIAL AND METHOD. Ninety-nine patients scheduled for TKA under spinal anesthesia were enrolled after written informed consent, and randomized into two groups with either periarticular injection of 20 ml 0.25% bupivacaine (B-gr n = 50) or isotonic saline solution (S-gr n = 49). All patients had intrathecal morphine 0.2 mg and single shot FNB with 20 ml bupivacaine 0.25% and were adjusted postoperative analgesic requirement via patient controlled analgesia with morphine. Effect of postoperative pain control and requirement of additional analgesics were recorded. ⋯ Adding periarticular infiltration to femoral block and intrathecal morphine significantly enhances the quality of postoperative pain therapy in TKA patients. However combining three methods for analgesic therapy may be too much effort. Modifying infiltration techniques including continuous application needs further research.
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Randomized Controlled Trial
Single injection fascia iliaca block for pain control after arthroscopic anterior cruciate ligament reconstruction: a randomized, controlled trial.
Arthroscopic anterior cruciate ligament reconstruction (AACLR) is one of the orthopedic surgeries associated with moderate to severe post-operative pain. The fascia iliaca block (FIB), a block of the femoral nerve and lateralfemoral cutaneous nerve of the thigh, is relatively simple, safe, and provides effective analgesia post-operatively ⋯ The fascia iliaca block is effective for providing pain control for at least 24 hours after anterior cruciate ligament reconstruction. This technique is quite easy, safe, and inexpensive to use.
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Randomized Controlled Trial
Result of percutaneous disc decompression using nucleoplasty in Thailand: a randomized controlled trial.
Chronic low back pain is a major social, economic and healthcare issue in the Thailand. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression and fusion. The percutaneous access to the disc was first used in the 1950s to biopsy the disc with needles. Percutaneous access to the disc using endoscopic techniques was developed in the 1970s. Nucleoplasty has emerged as one of the minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs which utilizes coblation technology for ablating and coagulating the nucleus for a partial disc removal. ⋯ Nucleoplasty appears to be safe and effective in Thailand. Is an effective procedure for patients presenting with discogenic back and/or radicular pain that have failed conservative therapies and are not considered candidates for open surgical interventions. A result of this analysis indicated that PDD using Coblation technology, also referred to as nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.