The Effect of Preoperative Interscalene Block Using Low-Dose Mepivacaine on the Postoperative Pain after Shoulder Arthroscopic Surgery

BACKGROUND: Shoulder arthroscopic surgery is frequently associated with severe postoperative pain, which can be difficult to manage without the use of high-dose opioids. Although an interscalene brachial plexus block (ISBPB) can be used to provide anesthesia for shoulder arthroscopic surgery, its effect using low-dose mepivacaine on postoperative pain management has not been reported. We hypothesized that ISBPB using a low-dose mepivacaine can provide effective postoperative analgesia for shoulder arthroscopic surgery without the need for high-dose opioids and act as a significant motor or sensory block. METHODS: This study examined a total of 40 patients, who underwent shoulder arthroscopic surgery, and received ISBPB with 10 ml of normal saline (group NS; n = 20) or 10 ml of 1% mepivacaine with epinephrine 1:200,000 (group MC; n = 20). The block was performed preoperatively. The postoperative pain score, opioid consumption, and side effect were recorded. RESULTS: The visual analog scale scores were significantly lower in group MC than in group NS at 120 minutes after shoulder arthroscopic surgery (1.9 +/- 1.0 versus 4.0 +/- 1.4). Group MC showed significantly lower fentanyl consumption after shoulder arthroscoic surgery than group NS (27 +/- 32.6 versus 79 +/- 18.9microgram). The degree of motor and sensory block after surgery was minimal. CONCLUSIONS: ISBPB using low-dose mepivacaine reduced the level of postoperative pain and fentanyl consumption without significant side effects. ISBPB using low-dose mepivacaine is a useful analgesic technique for shoulder arthroscopic surgery.

Hemodynamic Changes using Partial CO2 Rebreathing Method and Esophageal Doppler Monitor during Bilateral Total Knee Replacement Arthroplasty / 대한마취과학회지

BACKGROUND: We studied hemodynamic changes using a noninvasive partial CO2 rebreathing cardiac output method (NICO) and esophageal Doppler monitor (EDM), and metabolic changes in elderly patients undergoing bilateral total knee replacement arthroplasty (BTKA). METHODS: Twenty patients undergoing BTKA were studied. Hemodynamic and metabolic parameters were measured before tourniquet inflation (TI), 0, 3, 6, 9, 15, 30, 45 min after TI, and 0, 3, 6, 9, 15, 30 min after tourniquet deflation (TD) and skin suture. Stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were measured using NICO and EDM. RESULTS: Mean blood pressure (MBP), central venous pressure (CVP), and SVR had significant increases in TI, and decreases in TD compared with value measured before TI (baseline value). Especially, MBP had higher decrease in the second tourniquet compared with first tourniquet, SV and CO were decreased in TI, and increased in TD compared with baseline value, HR had significant increases in the TD of second tourniquet. pH and lactate were shown significantly lower values at the second tourniquet compared with the first tourniquet (P < 0.05). The bias and precision derived from CO between EDM and NICO was 0.27 +/- 0.41 L/min, and CO by NICO was smaller than that by EDM. The correlation coefficient between NICO and EDM was calculated to be 0.43. CONCLUSIONS: MBP, SV, CO, pH and lactate were shown to be higher in the second tourniquet in BTKA. NICO showed lower CO compared with EDM after TD in patients undergoing BTKA, but statistically insignificant at most measurement.

The Perioperative Anesthetic Management of Total Knee or Hip Replacement Arthroplasty: A Retrospective Study / 대한마취과학회지

BACKGROUND: Recently, joint replacement arthroplasty has been increasing. We report retrospective study on preoperative assessments, anesthetic managements, and postoperative complications of patients with total knee replacement arthroplasty (TKR) or total hip replacement arthroplasty (THR). METHODS: Four hundred ninety-seven cases of TKR or THR operations were investigated. Age, body mass index, operation time, total input, total output, blood loss, transfusion, and complications with corresponding treatments were obtained from chart review and anesthesia records, and statistically analyzed. RESULTS: In 497 patients, most patients (91.5%) suffered arthroplasty under regional anesthesia. 78.0% of patients had one or more coexisting diseases, where hypertension was the most common. Blood loss and transfusion were more in THR than TKR during the operations (P < 0.05). But, TKR developed more blood loss after operation than THR because of the tourniquet usage, and especially in both TKR, blood loss reached approximately up to 47.8% of the estimated blood volume on the operation day. Postoperative complications were observed mostly on the operative and postoperative first days. Common complications were itching, nausea and vomiting, and hypotension which had no significant differences between anesthetic types. CONCLUSIONS: We concluded that anesthetic types for arthroplasty did not give statistically significant difference in postoperative complications. The blood loss was extremely high that it compromised the elderly patient with coexisting diseases. More surgical complications were observed in both TKR cases than in unilateral TKR cases. There must be precise preoperative assessment of health status and intensive postoperative management in the operative day.

Effect of Autotransfusion Using the Drained Blood after Bilaterla Total Knee Arthroplasty / 대한마취과학회지

BACKGROUND: This study investigated the clinical usefulness of an autotransfusion of drained blood using postoperative wound drainage and a reinfusion system to reduce the allogenic blood transfusion without complications. METHODS: Eighty patients were allocated randomly to either a control group using a standard drainage system or an autotransfusion group using postoperative wound drainage and a reinfusion system. The collection period was 12 h, and the drainage blood retransfused after 6 h, or a maximum of 500 ml of blood was collected after connecting the reinfusion system. Immediately before reinfusion, blood samples were taken from the reinfusion system and analyzed for the functional and metabolic status of the drained blood and compared with the preoperative values of patient. The hemoglobin level, blood loss, allogenic blood requirement and transfusion-related complications were assessed. RESULTS: The drained blood had lower hematological values, a prolonged PT and aPTT, a lower fibrinogen, and metabolic acidotic status than the preoperative values of the patients. There were no significant differences in the amount of blood loss compared with the control group. However, the autotransfusion group required significantly less allogenic blood (almost 20% less) without significant complications. CONCLUSIONS: Autotransfusion by reinfusion with drained blood in bilateral total knee arthroplasty reduces the allogenic blood requirement without significant complications.