effect of intraarticular levobupivacaine and bupivacaine injection / on the postoperative pain management in total knee arthroplastic surgery

Total knee arthroplasty [TKA] is associated with considerable postoperative pain. We compared the effects of intraoperative intraarticular levobupivacaine and bupivacaine on postoperative analgesia and analgesic consumption after total knee arthroplasty. Sixty ASA [American Society of Anesthesiologists] physical status II-III, 18-75 years old patients scheduled for unilateral TKA were included in this study. For the operative procedure combined spinal epidural anesthesia was given by injecting 15mg levobupivacaine in subarachnoid space at L[3-4]/L[4-5] in sitting position for all patients. In Group L 20ml levobupivacaine [0.5%], in Group B 20ml bupivacaine [0.5%] was injected intraarticularly 10 minutes before opening of the tourniquet at the end of the surgery. For all patients postoperative analgesia was provided with PCEA [levobupivacaine+fentanyl] and oral 1gr paracetamol four times a day. Patients' intraoperative-postoperative hemodynamical data, postoperative sensorial-motor block characteristics, side effects, PCEA demand ratios and bolus volumes, total analgesic consumption, VAS values, first mobilization time, hospitalization time were recorded. Statistical analysis was performed with SPSS version 13.00 software. There was no intergroup difference in demographic data, hemodynamical data, PCEA demand ratios, total analgesic consumption, first mobilization time, hospitalization time and VAS values at 0,2,72 hour. Postoperative lower VAS values were determined at 4,8,12,24 hours in Group B and at 48[th] hour in Group L [p<0.05]. Intraarticular local anesthetic administration in addition to PCEA for post operative pain relief provides good analgesia after TKA surgery

Pre-emptive analgesic and haemodynamic efficacy of combined spinal-epidural neostigmine delivery

To determine the effect of pre-emptive epidurally administered 4 or 8 mcg/kg neostigmine on analgesia, mean arterial pressure, heart rate and side effects in intra and postoperative period. Randomized, double blinded, controlled clinical trial. Ankara Numune Training and Research Hospital, Turkey, from January to December 2008. Forty-five patients scheduled for lower extremity surgery were included in the study following the approval of the ethics committee and the patients. The study group was split into three groups and received combined spinalepidural anaesthesia. Diluting with 10 ml normal saline, group N4 and group N8 were delivered 4 mcg/kg and 8 mcg/kg epidural neostigmine, respectively, whereas group SF received 10 ml epidural saline. Lidocaine [2%] at 1.2 mg/kg dose was preferred for spinal anaesthesia. Analgesic efficacy, time to first analgesic requirement, Visual Analog Scale, Fentanyl consumption in the postoperative patient-controlled epidural analgesia, and delivered/required number of boluses, were evaluated. Haemodynamic data and side effects were noted. Statistically, analgesic consumptions at 12 and 24 hours in the N8 group was lower than those in the SF group, the number of delivered boluses was lower in the N8 group compared with the SF and N4 groups, number of required boluses was lower in the N8 group than in the SF group. In terms of haemodynamics and side effects, no difference was found between the groups regarding the entire intraoperative and postoperative parameters. Epidural Neostigmine administration at 8 mcg/kg was found to be a viable additional agent against analgesia, with the postoperative period depending on the dosage

Acute unilateral parotid gland swelling after lateral decubitus position under general anesthesia

Acute swelling of the parotid gland after general anesthesia [commonly known as anesthesia mumps or acute postoperative sialadenitis] is a rare but declared complication of anesthesia. The etiology is not clear, but some possible causes such as obstruction of glandular excretory ducts caused by patient position and increase in the viscosity of the saliva because of acute dehydratation and/or medications like atropin have been proposed. We report a swelling in the left preauricular and postauricular region extending to the angle of the mandibule in a 35-year-old patient after left lateral decubitus position for laparoscopic nephrectomy

Selective spinal anesthesia for inguinal herniorrhaphy

To determine the characteristic profiles of 2 hypobaric spinal anesthetic solutions for selective spinal anesthesia in inguinal herniorrhaphy. The study took place in the general surgery room of Anesthesia Department, Ankara Numune Research and Training Hospital between May and July 2005 as a prospective, randomized and double-blind trial. Sixty-one ASA I-III patients scheduled for inguinal herniorrhaphy were randomly divided into 2 groups. Group R received combined spinal epidural anesthesia with ropivacaine 7.5 mg and group B received bupivacaine 5 mg; in both groups 25 micro g of fentanyl was added. Solutions were diluted with 1.5 ml of sterile water. A Portex 18/27 or 16/27 needle was inserted at L1-2 or L2-3 with patients sitting upright; surgery began after the sensory block reached the T6 dermatome. Sensory and motor block characteristics, hemodynamic data, side effects, recovery time, the timing of the onset of pain, and the walkout were assessed. Motor block duration was shorter in Group R [56.1 +/- 36.1 minutes versus 72.5 +/- 23.3 minutes] [p=0.013]. Complete motor block duration was shorter in Group R. There was no difference between the 2 groups. Intra-group analysis showed that hemodynamic values after anesthesia induction were lower than initial values. Ropivacaine plus fentanyl provided similar sensory anesthesia, but with a shorter duration of motor block than bupivacaine plus fentanyl when used for selective spinal anesthesia in herniorrhaphy surgery. Furthermore, we suggest that hemodynamic should be carefully monitored during surgery

comparison of intra cuff pressures in high-flow and low-flow nitrous oxide anesthesia

To investigate intra cuff pressure changes in low-flow anesthesia [LFA] and high-flow [HFA] N2O anesthesia during moderate-duration surgical procedures. We carried out this prospective, randomized, single blind study at Numune Educational and Research Hospital, Ankara, Turkey between January to December 2005. Seventy patients aged between 18-65 years, American Society of Anesthesiologists [ASA] physical status grades I-III, undergoing elective surgery were enrolled in this study. Following a standardized induction, anesthesia was maintained with isoflurane [end-tidal 0.9-1%] at 4 L/minute for the HFA group, or 1 L/minute for the LFA group fresh gas flows. Endotracheal tube cuff [intra cuff] pressures were measured continuously with a pressure manometer, and inspired oxygen and N2O levels were noted every 10 minutes throughout the study. There was no significant difference between HFA and LFA groups for initial [first] cuff pressures [mean +/- SD, HFA=20.9 +/- 4.19, LFA=20.4 +/- 4.11, cmH2O], and maximum cuff pressures [MCP] [mean +/- SD, HFA=32.3 +/- 18.74, LFA=33.5 +/- 8.89, cmH2O] [p > 0.05]. The time to reach the maximum intra cuff pressure was significantly shorter in the LFA group [77.4 +/- 20.33 minutes], than the HFA group [89.3 +/- 23.94 minutes], [p=0.038]. Between the tenth and nineteenth minutes, inspired oxygen level was significantly higher in the HFA group [p=0.001], whereas inspired N2O was significantly higher in the LFA group [p=0.001]. The intra cuff pressures should be monitored carefully during LFA, since the duration to reach the maximum intra cuff pressures was shorter than that of HFA

Myasthenia gravis and sevoflurane: a case report

Myasthenia gravis is characterized by weakness and easy fatiguability of voluntary muscles. Myasthenic patients are sensitive to non-depolarizing relaxants. Sevoflurane, as an alternative, can be used to achieve good tracheal intubation. In this report, we present our experiences

Anesthesia for laparoscopic cholecystectomy: comparative evaluation of - desflurane/sevoflurane vs. propofol

Laparoscopic techniques, have rapidly increased in popularity because of its various benefits. They are widely used in daycase surgical operations and are extensively published. However, postoperative nausea vomiting [PONV] is a commonly observed phenomenon after laparoscopic procedures. Its occurrence may increase depending on the anesthetic techniques used. Despite the fact that the use of propofol and the new low solubility inhalation anesthetics, lead to faster induction and recovery, their effects on PONV is not sufficiently known. Therefore, the aim of this study is to compare the effects of various anesthetic drugs on recovery characteristics and PONV. Following informed consent, 300 ASA I-III patients scheduled for laparoscopic cholecystectomy were investigated. Anesthesia was induced by 1.5 micro gkg[-1] fentanyl, 0.03 mgkg[-1] midazolam, 1.5 mg kg[-1] propofol and 0.01 mgkg[-1] vecuronium for all patients. Anesthesia was maintained with desflurane in group D [n = 100], sevoflurane in group S [n = 100] and propofol infusion in group P [n = 100], beside 50% N[2]O/O[2] ventilation. All patients were given 4 mg ondansetron and 8 mg dexamethazone iv for preventing PONV, ten minutes before the end of surgery. At the end of the operation, times for extubation, eye opening, orientation, sitting and walking, and the need of ondansetrone in post anesthetic care unit, were recorded. Also, PONV was observed and recorded as early period [first 4 hours] and late period [4-24 hours]. Extubation and eye opening times were meaningfully lower in group D. However, no significant differences were observed in orientation, sitting and walking times and PONV among the three groups. All patients who had PONV were women. A correlation was found between PONV and body weight. Even though there were no statistically significant differences among the groups regarding PONV, the number of patients who had PONV in group P was lower. Early recovery time was shortest in group D, while delayed recovery time had no differences. It may be said that these anesthetic drugs have no statistically significant difference for PONV and delayed recovery