ABSTRACT
Abstract Objectives: The aim of the present study was to investigate the preventive effects of propofol and ketamine as small dose sedation during spinal anaesthesia on tourniquet-induced ischaemia-reperfusion injury. Methods: 30 patients were randomly assigned into two groups of 15 patients. In the propofol group, sedation was performed with propofol 0.2 mg·kg-1 followed by infusion at a rate of 2 mg·kg-1·h-1. In the ketamine group, a continuous infusion of ketamine 0.5 mg·kg-1·h-1 was used until the end of surgery. Intravenous administration of midazolam was not used in any patients. Ramsay sedation scale was used for assessing the sedation level. Venous blood samples were obtained before propofol and ketamine infusion (T1), at 30 minutes (min) of tourniquet ischaemia (T2), and 5 min after tourniquet deflation (T3) for malondialdehyde (MDA) measurements. Results: No differences were noted between the groups in haemodynamic (p > 0.05) and demographic data (p > 0.05). There was no statistically significant difference between the two groups in terms of T1, T2 and T3 periods (p > 0.05). There was a statistically increase observed in MDA values respectively both in Group P and Group K between the reperfusion period (1.95 ± 0.59, 2.31 ± 0.48) and pre-ischaemia (1.41 ± 0.38, 1.54 ± 0.45), and ischaemia (1.76 ± 0.70, 1.71 ± 0.38) (µmoL-1) periods (p < 0.05). Conclusions: Small-dose propofol and ketamine has similar potential to reduce the oxidative stress caused by tourniquet-induced ischaemia-reperfusion injury in patients undergoing arthroscopic knee surgery under spinal anaesthesia.
Resumo Objetivos: O objetivo do presente estudo foi investigar os efeitos preventivos de propofol e cetamina em sedação com doses baixas durante a raquianestesia sobre lesão de isquemia-reperfusão induzida por torniquete. Métodos: 30 pacientes foram randomicamente alocados em dois grupos de 15 pacientes cada. No grupo propofol, a sedação foi feita com 0,2 mg.kg-1 de propofol seguida por infusão a uma taxa de 2 mg.kg-1.h-1. No grupo cetamina, uma infusão contínua de 0,5 mg.kg-1.h-1 de cetamina foi usada até o final da cirurgia. Midazolam intravenoso não foi administrado em nenhum dos pacientes. A Escala de Sedação de Ramsay (ESR) foi usada para avaliar o nível de sedação. Amostras de sangue venoso foram colhidas antes da administração de propofol e infusão de cetamina (T1), aos 30 minutos (min) de isquemia do torniquete (T2) e 5 min após a desinsuflação do torniquete (T3), para medir os valores de malondialdeído (MDA). Resultados: Não observamos diferenças entre os grupos em relação à hemodinâmica (p > 0,05) e dados demográficos (p > 0,05). Não houve diferença estatisticamente significativa entre os dois grupos nos períodos T1, T2 e T3 (p > 0,05). Um aumento estatisticamente significativo foi observado nos valores de MDA, respectivamente, no Grupo P e Grupo C entre os períodos de reperfusão (1,95 ± 0,59, 2,31 ± 0,48) e pré-isquemia (1,41 ± 0,38, 1,54 ± 0,45) e isquemia (1,76 ± 0,70, 1,71 ± 0,38) (µmoL-1) (p < 0,05). Conclusões: Propofol e cetamina em doses baixas apresentam potencial semelhante para reduzir o estresse oxidativo causado pela lesão de isquemia-reperfusão induzida por torniquete em pacientes submetidos à artroscopia de joelho sob raquianestesia.
Subject(s)
Humans , Male , Female , Adult , Tourniquets/adverse effects , Reperfusion Injury/etiology , Reperfusion Injury/prevention & control , Propofol/administration & dosage , Hypnotics and Sedatives/administration & dosage , Ketamine/administration & dosage , Anesthesia, Spinal/methods , Anesthetics, Dissociative/administration & dosage , Antioxidants/administration & dosage , Prospective StudiesABSTRACT
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
Subject(s)
Humans , Male , Female , Bupivacaine/analogs & derivatives , Bupivacaine , Injections, Intra-Articular , Pain, Postoperative , Disease Management , Analgesia , AnalgesicsABSTRACT
To evaluate the effect of intraoperative low-dose ketamine with general anesthesia on postoperative pain after total knee replacement surgery. A randomized, double-blind comparative study. Ankara Numune Training and Research Hospital, Turkey, from January and June 2011. Sixty adults undergoing total knee arthroplasty were enrolled in this study. The patients were randomly allocated into two groups of equal size to receive either racemic ketamine infusion [6 microg/kg/minute] or the same volume of saline. A visual analogue scale [VAS] was used to measure each patient's level of pain at 1, 3, 6, 12, and 24 hours after surgery. Time to first analgesic request, postoperative morphine consumption and the incidence of side effects were also recorded. Low-dose ketamine infusion prolonged the time to first analgesic request. It also reduced postoperative cumulative morphine consumption at 1, 3, 6, 12, and 24 hours postsurgery [p < 0.001]. Postoperative VAS scores were also significantly lower in the ketamine group than placebo, at all observation times. Incidences of side effects were similar in both study groups. Intraoperative continuous low-dose ketamine infusion reduced pain and postoperative analgesic consumption without affecting the incidence of side effects
ABSTRACT
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
ABSTRACT
The aim of this randomized, double-blind, placebo-controlled study was to evaluate the effect of ephedrine pretreatment on the intensity of rocuronium injection pain when rocuronium was applied by timing principle and also to compare this effect with lidocaine and placebo. 120 American Society of Anesthesiology risk score I-II patients scheduled for elective surgery under general anesthesia were randomized into three groups to receive either 70 micro g/kg ephedrine [ephedrine group, n = 40] or 0.5 mg/kg lidocaine [lidocaine group, n = 40] or 5 ml NaCl 0.9% [placebo group, n = 40] as pretreatment. Thirty seconds after pretreatment drugs, rocuronium 0.6 mg/kg was administered by the timing principle and rocuronium injection pain scores were recorded. Twenty seconds after rocuronium administration, anesthesia was induced with thiopental and the patient's trachea was intubated. Hemodynamic parameters and adverse effects were recorded. The overall frequency of having pain was 82.5, 52.5 and 22.5% in placebo, ephedrine and lidocaine groups, respectively. Although the frequency of mild and moderate pain scores was higher in the ephedrine group than in the lidocaine group, this difference was not statistically significant [p = 0.032 and p = 0.001, respectively]. Although not as effective as lidocaine 0.5 mg/kg, 70 micro g/kg ephedrine pretreatment was able to alleviate rocuronium injection pain when rocuronium was applied by timing principle