ABSTRACT
Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.
Subject(s)
Humans , Accidental Falls , Analgesia , Arthroplasty , Arthroplasty, Replacement, Knee , Early Ambulation , Femoral Nerve , Knee , Nerve Block , Pain Management , Peripheral Nerves , Postoperative Complications , Quadriceps Muscle , RehabilitationABSTRACT
We present successful epidural anesthesia and assisted mechanical ventilation in a parturient woman with respiratory failure. A 41-year-old woman at 35 weeks' of gestation was entering labor. She was pneumonectomized on the left, had bronchiectasis on the remnant lung, and was under assisted mechanical ventilation by continuous positive airway pressure (CPAP) because of severely restricted lung function and superimposed pneumonia. We administered continuous epidural analgesia for vaginal delivery, and extended it for cesarean section after failure of vaginal delivery. During the procedure, her ventilation was continuously assisted by CPAP. The maternal and fetal outcomes were successful.
Subject(s)
Female , Humans , Pregnancy , Analgesia, Epidural , Anesthesia , Anesthesia, Epidural , Bronchiectasis , Cesarean Section , Continuous Positive Airway Pressure , Lung , Pneumonia , Respiration, Artificial , Respiratory Insufficiency , VentilationABSTRACT
Whole lung lavage (WLL) is a challenging procedure; because lavage fluid may perturb the respiratory and hemodynamic systems. We observed severe airway obstruction and flattening arterial pressure wave during WLL for treatment of pulmonary alveolar proteinosis. The aim of this case report is to discuss the anesthetic requirement in order to prevent bronchospasm during WLL. Furthermore, we discuss the potential of lavage fluid to cause airway obstruction and decrease cardiac outflow through the mass effect.
Subject(s)
Airway Obstruction , Arterial Pressure , Bronchial Spasm , Bronchoalveolar Lavage , Hemodynamics , Lung , Pulmonary Alveolar Proteinosis , Therapeutic IrrigationABSTRACT
Dexmedetomidine, which is a selective alpha2-adrenoceptor agonist, was recently introduced into clinical practice for its analgesic properties. The purpose of this study was to evaluate the effects of dexmedetomidine in a vincristine-evoked neuropathic rat models. Sprague-Dawley rats were injected intraperitoneally with vincristine or saline (0.1 mg/kg/day) using a 5-day-on, 2-day-off schedule for 2 weeks. Saline and dexmedetomidine (12.5, 25, 50, and 100 microg/kg) were injected to rats developed allodynia 14 days after vincristine injection, respectively. We evaluated allodynia at before, 15, 30, 60, 90, 120, 180, and 240 min, and 24 hr after intraperitoneal drug (normal saline or dexmedetomidine) injection. Saline treatment did not show any differences for all the allodynia. Maximal paw withdrawal thresholds to mechanical stimuli were 3.0 +/- 0.4, 9.1 +/- 1.9, 13.0 +/- 3.6, 16.6 +/- 2.4, and 24.4 +/- 1.6 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Minimal withdrawal frequency to cold stimuli were 73.3 +/- 4.2, 57.1 +/- 6.8, 34.3 +/- 5.7, 20.0 +/- 6.2, and 14.3 +/- 9.5 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Dexmedetomidine shows a dose-dependent antiallodynic effect on mechanical and cold stimuli in vincristine-evoked neuropathic rat models (P < 0.05).
Subject(s)
Animals , Male , Rats , Analgesics/therapeutic use , Behavior, Animal/drug effects , Dexmedetomidine/therapeutic use , Disease Models, Animal , Hyperalgesia/chemically induced , Injections, Intraperitoneal , Pain Threshold , Rats, Sprague-Dawley , Vincristine/toxicityABSTRACT
Dexmedetomidine, which is a selective alpha2-adrenoceptor agonist, was recently introduced into clinical practice for its analgesic properties. The purpose of this study was to evaluate the effects of dexmedetomidine in a vincristine-evoked neuropathic rat models. Sprague-Dawley rats were injected intraperitoneally with vincristine or saline (0.1 mg/kg/day) using a 5-day-on, 2-day-off schedule for 2 weeks. Saline and dexmedetomidine (12.5, 25, 50, and 100 microg/kg) were injected to rats developed allodynia 14 days after vincristine injection, respectively. We evaluated allodynia at before, 15, 30, 60, 90, 120, 180, and 240 min, and 24 hr after intraperitoneal drug (normal saline or dexmedetomidine) injection. Saline treatment did not show any differences for all the allodynia. Maximal paw withdrawal thresholds to mechanical stimuli were 3.0 +/- 0.4, 9.1 +/- 1.9, 13.0 +/- 3.6, 16.6 +/- 2.4, and 24.4 +/- 1.6 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Minimal withdrawal frequency to cold stimuli were 73.3 +/- 4.2, 57.1 +/- 6.8, 34.3 +/- 5.7, 20.0 +/- 6.2, and 14.3 +/- 9.5 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Dexmedetomidine shows a dose-dependent antiallodynic effect on mechanical and cold stimuli in vincristine-evoked neuropathic rat models (P < 0.05).
Subject(s)
Animals , Male , Rats , Analgesics/therapeutic use , Behavior, Animal/drug effects , Dexmedetomidine/therapeutic use , Disease Models, Animal , Hyperalgesia/chemically induced , Injections, Intraperitoneal , Pain Threshold , Rats, Sprague-Dawley , Vincristine/toxicityABSTRACT
BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Subject(s)
Aged , Humans , Analgesics, Opioid , Anesthesia , Anesthesia, Spinal , Anesthetics, Local , Bupivacaine , Fentanyl , Needles , Outpatients , Pruritus , ShiveringABSTRACT
BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Subject(s)
Aged , Humans , Analgesics, Opioid , Anesthesia , Anesthesia, Spinal , Anesthetics, Local , Bupivacaine , Fentanyl , Needles , Outpatients , Pruritus , ShiveringABSTRACT
BACKGROUND: Few studies have been conducted to evaluate the reliability of the various tools used to assess cognitive and psychomotor recovery after ambulatory anesthesia. Therefore, this study was conducted to compare the sensitivity and reliability of simple, standard tests used to measure postoperative cognitive and psychomotor functions. METHODS: Twenty-seven patients admitted for same day surgery were included in this prospective, randomized study. While in the preanesthetic unit, each patient was asked to perform three different standard psychometric tests, the digit symbol substitution test (DSST), digit span test (DST), and perceptual speed test (PST), to evaluate cognitive and psychomotor functions. The results were then used as baseline values that were subsequently compared to results obtained when patients repeated the tests at 15, 30 and 60 min after extubation. In addition, the observer's assessment of alertness and sedation was evaluated. RESULTS: The DSST scores were significantly lower than the baseline scores at 15 and 30 min after extubation, with a performance ratio of 64.9 and 89.2, respectively (P < 0.05). The DST scores had returned to preanesthetic levels at 30 min post-anesthesia and the PST scores were found to be significantly higher than the baseline scores at 30 and 60 min post-anesthesia. CONCLUSIONS: DSST is a more sensitive indicator of residual drug effect following anesthesia than the other tests evaluated in this study. In addition, a learning effect was obvious when the PST was administered.