ABSTRACT
Objective To investigate the effectiveness and safety of wound infiltration with rop-ivacaine for postoperative analgesia as a fast-track approach in patients undergoing open hepatectomy. Methods Fifty-two patients with hepatocellular carcinoma,32 males,20 females,aged 18-70 years, scheduled for selective open hepatectomy were enrolled in this trible-blind,randomized,controlled study.Patients were randomized to receive 0.75% ropivacaine (group ROP)or 0.9% normal saline (group NS)wound infiltration before incision closures at a total volume of 10 ml.Numerical rating score (NRS)at 6,12,24 and 48 hours after surgery,length of hospital stay,time to bowel recovery,ambulation and drainage tube extraction were recorded.Side effects, including post-operative liver and renal function,allergic reaction,nausea and vomiting,and wound infection,were also assessed.Results NRS was significantly decreased at 6 [(3.85±1.29)scores vs.(5.30±1.76) scores],12 [(3.38±0.85)scores vs.(5.69 ±1.38)scores]and 24 hours [(3.69 ±0.74)scores vs. (4.42±1.13)scores]after surgery in group ROP compared to group NS (P <0.05).Group ROP al-so showed shorter postoperative hospital stays [(1 7.92±1.97)d vs.(1 9.53±2.42)d],earlier anal exsufflation [(48.07±7.49)h vs.(53.42±10.38)h]and ambulation [(2.34±0.62)d vs.(2.80± 0.84)d](P <0.05).However,there were no significant differences between the two groups in re-garding post-operative liver and renal function.The incidence of nausea and vomiting was 1 5% (4 ca-ses)and 1 9%(5 cases)in group NS and group ROP,respectively.No allergic reactions occurred in either group.Conclusion The present study shows that ropivacaine wound infiltration could effectively release post-operative pain,and could be a safe and effective fast-track approach for patients undergoing open hepatectomy.
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Objective To investigate the impact of thoracic epidural anesthesia on stress hyper-glycemia in patients undergoing major abdominal operations.Methods Forty patients were divided in-to two groups:general anesthesia (group I)and thoracic epidural and general anesthesia (group E). The venous samples were collected for the measurements of blood glucose (Glu),nitric oxide (NO), malonadialdehyde (MDA),glutathione (GSH)and the activities of aldose reductase (AR),glucose-6-phasphate dehydrogenase (G-6PD), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD),catalase(CAT)in red blood cells at 30 min before induction (T0 ),90 min after incision (T1 ),60 min after surgery (T2 )and on the 1st,2nd postoperative day (T3 and T4 ).Results The lev-el of Glu was increased from T1 to T3 in two groups compared with T0 .The activities of AR,G-6PD and CAT in RBC and plasma MDA were increased markedly at T3 while plasma levels of GSH and NO were decreased significantly in group I (P<0.05).Above parameters,except Glu,changed slightly and did not reach significance in group E.Compared to group I,the level of Glu and the activities of AR,G-6PD,CAT in group E were decreased and NO level was increased significantly at T3 (P <0.05).SOD and GSH-Px activity changed slightly within and between two groups.Conclusion Tho-racic epidural anesthesia can effectively attenuate stress hyperglycemia in patients undergoing major abdominal surgery.
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Objective To investigate the effects of mannitol on the activity of erythrncyte aldose reduclase (AR),plasma nitric oxide(NO)and malondialdehyde(MDA)concentrations in patients undergoing hepatolobectomy.Methods Forty ASA Ⅰ or Ⅱ patients(aged 24-63 yr and weighing 50-68 kg),receiving combined general and epidural anesthesia and undergoing selective hepatolobectomy,were randomly assigned into a mannitol group (group M)and a normal saline group(group C).During hepatic portal occlusion,normal saline 1.5 ml/kg and 20％ mannitol 1.5 ml/kg were intravenously infused in groups C and M respectively for 30 min.Venous blood samples were collected to measure the erythrocyte AR activity and plasma NO and MDA concentrations at the following time points:before anesthesia induction(T0),at the end of hepatic portal occlusion(T1),at the end of operation(T2),one day after operation(T3)and three days after operation(T4),respectively.Results Compared with group C at T1,2,the erythrocyte AR and plasma MDA concentration decreased while plasma NO concentration increased in group M(P ＜ 0.05).Conclusion Mannitol can reduce hepatic ischemia and reperfusion injury in patients undergoing hepatolobectomy,which may be related to the mechanism of mannitol removing oxygenderived free radicals and inhibiting lipid peroxidation.
ABSTRACT
Objective To study the changes in the polyol pathway of glucose metabolism and oxidative stress responses induced by general thoracic surgery by measuring erythrocyte aldose reductase (AR), phosphofructokinase (PFK) and glucose-6 phospate dehydrogenase (G-6PD) activities and plasma MDA and GSH levels before and after surgery performed under different anesthetic techniques. Methods Thirty-two ASA Ⅰ-Ⅱ patients aged 45-71 yrs weighing 55-70 kg were randomly allocated to one of two groups with 16 patients in each group : group Ⅰ received isoflurane inhalation for maintenance of anesthesia and group Ⅱ isoflurane inhalation combined with epidural block. Patients with endocrine and glucose metabolism-related diseases were excluded. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Anesthesia was induced with intravenous midazolam 0.1 mg?kg-1 , propofol 1.0-1.5 mg?kg-1 , fentanyl 0.1-0.15 mg, droperidol 1-2 mg and vecuronium 0.1 mg?kg-1 in both groups. The patients were mechanically ventilated (VT 8-10 ml?kg-1, RR 10-12 bpm) after tracheal intubation. Anesthesia was maintained with isoflurane inhalation at 1.2-1.6 MAC in group Ⅰ or isoflurane inhalation (0.6-0.8 MAC) combined with epidural block (T9-10) with 1 % lidocaine in group Ⅱ supplemented with fentanyl 5-10 ?g?kg-1 and droperidol 0.1-0.2 mg?kg-1 in divided doses and vecuronium infusion at 1-2 ?g? kg?min-1 . Venous blood samples were obtained before anesthesia (baseline, T0), 90 min after skin incision (T1), 60 min after surgery (T2 ) and on the 1 st and 2nd postoperative days (T3 , T4 ) for determination of erythrocyte AR, PFK and G-6PD activities and plasma glucose, MDA and GSH levels. Results In group Ⅰ plasma MDA level and AR and G-6PD activities in erythrocyte were significantly increased, while plasma GSH level and PFK activity in erythrocyte were significantly decreased on the 1st postoperative day compared to the baseline values before anesthesia (T0) (P 0.05). Conclusion Isoflurane inhalation combined with epidural block can effectively attenuate the effects of surgical trauma on glucose metabolism in theerythrocyte and the oxidative stress responses of the body.