Articles: postoperative.
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled TrialMinimum Effective Volume of Combined Lidocaine-Bupivacaine for Analgesic Subparaneural Popliteal Sciatic Nerve Block.
The aim of this study was to determine the minimum effective volume (MEV) of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL in 90% of patients (MEV90) for ultrasound-guided subparaneural popliteal sciatic nerve block. ⋯ For ultrasound-guided subparaneural (analgesic) popliteal sciatic nerve block, the MEV90 of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL is 13.3 mL (95% confidence interval, 10.2-16.4 mL).
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Age-related changes in skin contribute to impaired wound healing after surgical procedures. Changes in skin with age include decline in thickness and composition, a decrease in the number of most cell types, and diminished microcirculation. The microcirculation provides tissue perfusion, fluid homeostasis, and delivery of oxygen and other nutrients. ⋯ Judicious use of fluids, maintenance of normal body temperature, pain control, and increased tissue oxygen tension are examples of adjustable variables that support the microcirculation. Anesthetic agents influence the microcirculation of a combination of effects on cardiac output, arterial pressure, and local microvascular changes. The authors examined the role of anesthetic management in optimizing the microcirculation and potentially improving postoperative wound repair in older persons.
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Reg Anesth Pain Med · Mar 2014
Prolonged Amelioration of Experimental Postoperative Pain by Bupivacaine Released From Microsphere-Coated Hernia Mesh.
Postoperative pain alters physiological functions and delays discharge. Perioperative local anesthetics are effective analgesics in the immediate 1- to 2-day postoperative period, but acute pain often lasts longer. The goal of this work was to develop a local anesthetic formulation adhering to an intraoperative implanted device that reduces pain for at least 3 days after surgery. ⋯ Bupivacaine slowly released for 72 hours from microspheres adsorbed to the hernia mesh significantly suppresses evoked postoperative hypersensitivity for at least 1 week and is more effective than a suspension of these microspheres or preoperative single-shot infiltration of bupivacaine.