Cahiers d'anesthésiologie
-
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.
-
The occurrence of bleeding in trauma patients is a life-threatening problem which can be explained by different mechanisms. The infusion of cristalloids, colloids, packed red blood cells, or even fresh frozen plasma is very rarely responsible for bleeding but it can contribute to dilute the patient's platelet pool, and especially dilutional thrombocytopenia is the first cause of bleeding after massive transfusion. Blood coagulation factor activity is decreased after a massive fluid infusion is performed but it has to reach a dramatically low plasma level in order to induce troubles. ⋯ Hypothermia can also impair platelet function and worsen the bleeding. A simplified monitoring of haemostasis can be proposed with platelet count, whole blood coagulation clotting time, immediately available activated partial thromboplastin time and prothrombin time with bedside portable monitors and thromboelastography. Haematocrit and body temperature have to be monitored as well.
-
General anaesthesia is often required for burns dressing. Ketamine was the most common agent for carrying out removal of adherent dressings. Disadvantages are delirium on emergence from anaesthesia and prolonged recovery. ⋯ Mean time of recovery was less than 15 min. Unpleasant dreaming occurred in 3 patients only, without agitation. The technique proved to be simple, effective and should revive interest for ketamine in the management of burned patients.
-
This review describes the mechanisms of analgesic effect, advantages and risks related to the perioperative use of non steroidal antiinflammatory drugs (NSAID's). The NSAID's should be used as the first analgesic, around the clock, with a rapid onset of the therapy. Their combination with other NSAID's (acetaminophen) or opioids can have an additive analgesic effect and may limit frequent secondary effects as nausea and vomiting. Their potential toxicity must be remembered and the contra indications, maximum doses and duration of treatment have to be respected.
-
The use of a pneumatic tourniquet to provide a bloodless field in orthopedic surgery is often complicated by tourniquet pain. The mechanism of this pain remains incompletely understood, but it is probably multifactorial. Nerve compression is a common etiologic feature. ⋯ Superficial (skin) compression and deep components compression like blood vessels and muscles can both induce tourniquet pain. Central nervous system can also interfere. Release of tourniquet can increase the pain by post-ischaemic oedema due to ischaemia and reperfusion injury.