Cahiers d'anesthésiologie
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Postoperative pain after shoulder surgery is known to be intense and requires usually opioid administration. The recent use of regional anaesthesia for this type of surgery has contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. Moreover, the development of less invasive surgery (arthroscopy) and experience with regional blocks have permitted to perform minor shoulder surgery on an outpatient basis. ⋯ However, for more invasive surgery, regional anaesthesia should be associated to a light general anaesthesia as well as the insertion of a supraclavicular catheter for postoperative analgesia. A diaphragmatic paresis secondary to a blockade of the phrenic nerve is constant radiologically after interscalenic block but remains symptomless. However, in case of severe preoperative chronic respiratory insufficiency, decompensation may occur rapidly after performance of the interscalenic block.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of sufentanil and fentanyl in urologic surgery in adults].
Sufentanil is compared with fentanyl as a supplement to N2O isoflurane anaesthesia in a double blind study of 30 elderly patients undergoing major urological surgery. Comparison is made with respect to 1) haemodynamic (heart rate, blood pressure) responses during surgery and recovery; 2) time to extubation after the end of surgery; 3) Postoperative analgesia. No difference is observed between the two groups with respect to demographic data, duration of surgery, and total doses of muscle relaxants. ⋯ Times between end of surgery and extubation are different: 77 +/- 13 min the sufentanil group versus 57 +/- 22 min the fentanyl group (p < 0.05). Use of analgesia is significantly delayed in the sufentanil group. It is suggested that sufentanil, in elderly patients, provides a better haemodynamic stability and a greater residual analgesia than fentanyl in the immediate postoperative period.
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The advantages of regional over general anaesthesia have led to an increased use of peripheral nerve blocks. Among the few risks of regional anaesthesia are those of overdosage, systemic and neural toxicity. Techniques have been proposed to improve the success of peripheral nerve blocks and to avoid nerve damage or systemic toxicity. Nerve stimulator, anatomic landmarks, needles and anaesthetic solutions are discussed.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesia with intra-articular injection of buprenorphine after surgery of the shoulder].
The effect of 10 ml of intra-articular buprenorphine (0.30 mg) or normal saline on postoperative pain after shoulder surgery was studied in a randomized, prospective, double-blind study in 30 ASA I-II patients receiving general anaesthesia. The pain scores (Five Point Scale ranging from "no pain" to "unbearable pain" and Visual Analog Pain Scale) 1, 2, 3, 4, 6 and 24 hours after surgery, time to first analgesic use and total 6-hours and 24-hours analgesic requirements were recorded. VAPS was significantly lower in the buprenorphine group compared with placebo-treated patients one hour after surgery (p < 0.05). ⋯ No significant differences were detected in total 24-h analgesic requirements between the two groups. These results indicate that intra-articular injection of buprenorphine after shoulder surgery provides short analgesia. This effect may be mediated by systemic absorption.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Clinical Trial[Effects of preoxygenation methods on the course of PaO2 and PaCO2 in anesthetic post-induction apnea].
This study compares two preoxygenation techniques by blood gases measurements during induction of anaesthesia. After hospital ethics committee approval, 17 adult surgical patients, ASA I, all free of cardiac or lung disease were randomly assigned to two groups. Before preoxygenation, venous and radial artery canulations were performed. ⋯ The group I had significantly higher PaO2 immediately after preoxygenation (397 +/- 49 vs 293 +/- 86 mmHg) and the time for SaO2 to decrease to 95% was significantly shorter in group II (3 +/- 1 vs 1.87 +/- 0.99 min). PaCO2 was not different after preoxygenation in group II. In summary, healthy and young patients receive better protection against hypoxia with normal breathing of 100% for 4 minutes.