Patient Satisfaction And Cost Analysis Of Analgesia Management For Post-Operative Procedures In Htaa: Pca Vs. Conventional Method

@#Acute pain service (APS) offer several techniques to the post-operative patient in controlling and relieving the pain such as intravenous infusion, patient-controlled analgesia, epidural infusion, subcutaneous or intramuscular injection and intrathecal administration. The effectiveness of and satisfaction towards APS is not clearly defined. Therefore, the aim of this study is to conduct the cost analysis and comparison between these techniques and patient satisfaction. The study design for cost analysis was retrospective study. The means of the data were calculated based on Integration Store of Hospital Tengku Ampuan Afzan records. In addition, the evaluation of patient’s satisfaction was conducted by using a cross-sectional study design. The mean of the data was calculated and analysed by using Chi-square test. The total cost required to prepare PCA for post-operative patient was the highest with RM 8810.98. Meanwhile, the cost for subcutaneous morphine injection, epidural infusion and peripheral block injection were RM 2.11, RM 5323.95 and RM 4.95 respectively. However, when taking into the aspect of patient’s satisfaction, PCA has the highest level of excellent performance with 54.6% compare to EDA (33%) and BLOCK (12.4%) with the p-value is less than 0.05. In conclusion, every drug has its own side effects. As the healthcare provider, it is a need to ensure drugs that were given to the patients are at the very minimum risk of having the side effects. Based on the findings of this study, it could be said that both drugs have lower percentage of people experienced the side effect after treated with the drugs. Therefore, the future study should be more focusing on the side effect of the drugs used. In terms of cost spent for the methods, the PCA regimen is more likely expensive compared to the conventional methods. However, based on survey among the patients, PCA-treated patients expressed higher satisfaction compared to the conventional regimen of pain management.

Efficacy of ultrasound-guided serratus anterior plane block for postoperative analgesia in patients undergoing thorascopic surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective thoracoscopic surgery under general anesthesia,were divided into 3 groups (n=20 each) using a random number table method:control group (group C),thoracic paravertebral block (PVB) group (group PVB) and group SAPB.After the patients were turned to contralateral position,thoracic PVB was performed at T4.6 thoracic vertebrae on the affected side under ultrasound guidance,and 0.25％ ropivacaine 20 ml was injected in group PVB.In group SAPB,ultrasoundguided SAPB was performed on the affected side,and 0.33％ ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores＞3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing,total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded,the dose was calculated,and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting,pulmonary infection and chronic pain was also recorded.Results Compared with group C,the consumption,dose and total consumption of sufentanil were significantly decreased,the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased,and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P＜0.05).Compared with group PVB,no significant change was found in the parameters in group SAPB (P＞0.05).There was no significant difference in the incidence of chronic pain among the three groups (P＞0.05),and no patients required additional flurbiprofen axetil.Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects.

Efficacy of ultrasound-guided adductor canal block for analgesia after tibial fracture / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided adductor canal block (ACB) for analgesia after tibial fracture.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective internal fixation for unilateral tibial fracture under general anesthesia,were enrolled in this study.The tracheal tube was removed after operation,and then the patients were admitted to the postanesthesia care unit.The visual analog scale score was recorded.Eighty patients with visual analog scale score＞3 were divided into 2 groups (n =40 each) using a random number table method:control group (group C) and ACB group.Patient-controlled intravenous analgesia (PCIA) was performed at the end of operation.Patients underwent ACB on the affected side,and 0.375％ ropivacaine 20 ml was injected in group ACB.Sufentanil 0.1-0.2 μg/kg was intravenously injected in group C.Ramsay sedation scores were recorded immediately after entering the postanesthesia care unit (T0) and at 15 and 30 min and 1,2,4,8 12 and 24 h after block (T1-8).When visual analog scale scores ＞3 points and the pain could not be relieved through pressing the PCA pump,tramadol 1-2 mg/kg was intramuscularly injected.Patients were followed up for 24 h after surgery,and the postoperative consumption of sufentanil,pressing time of PCA and patients' satisfaction scores were recorded.The occurrence of postoperative nausea and vomiting,respiratory depression and hypoxemia and length of postoperative hospital stay were also recorded.Results Compared with group C,the postoperative consumption of sufentanil,pressing time of PCA,requirement for and consumption of tramadol,incidence of postoperative nausea and vomiting and oversedation,and Ramsay sedation score at T1-5 were significantly decreased,and the patients' satisfaction score were increased in group ACB (P＜0.05).Conclusion Ultrasound-guided ACB exerts better analgesic efficacy after tibial fracture with fewer adverse reactions.

Efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in infants undergoing lobectomy under general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.Methods Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes,aged 1-3 yr,weighing 10-16 kg,scheduled for elective lobectomy under general anesthesia,were divided into 2 groups (n =30 each) using a random number table method:control group (group C) and epidural block group (group E).Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E.An epidural catheter was inserted at T6,7 interspace,0.1％ ropivacaine 1 mg/kg was injected at 5 min after injecting 1％ lidocaine 3 ml,the diffusion of epidural fluid was controlled at T3-10,and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score＞3,the pump was pressed.When pain was still unrelieved 5 min later,sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation,and the requirement for additional remifentanil and sufentanil,and the occurrence of postoperative nausea and vomiting,respiratory depression,hypoxemia and over-sedation was recorded.The number of pressing times,extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents.Results Compared with group C,the consumption of remifentanil,the number of pressing times and requirement for additional sufentanil were significantly decreased,the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery,the extubation time and duration of intensive care unit stay were shortened,and the incidence of nausea and vomiting and over-sedation was decreased in group E (P＜0.05).Conclusion Uhrasound-gnided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in infants undergoing lobectomy under general anesthesia / 中华麻醉学杂志

Objective@#To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.@*Methods@#Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T6, 7 interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents.@*Results@#Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05).@*Conclusion@#Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Effect of Eptazocine Hydrobromide Combined with Sufentanil on Postoperative Analgesia After Trans-urethral Resection Prostate / 医药导报

Objective To explore effect of eptazocine hydrobromide combined with sufentanil on postoperative analgesia after trans-urethral resection prostate ( TURP ). Methods One hundred and twenty adult patients undergoing TURP were randomly divided into three groups ( n＝40): eptazocine hydrobromide group ( group E), dezocine combined with sufentanyl group (group DS) and eptazocine hydrobromide combined with sufentanyl group (group ES).All patients received postoperative patient controlled intravenous analgesia (PCIA).The patients in the group E were given eptazocine hydrobromide with dose of 1 mg·kg-1;group DS patients were given with dezocine of 0. 3 mg·kg-1combined with sufentanil 1. 5 μg·kg-1;group ES patients were given eptazocine hydrobromide 0.2 mg·kg-1combined with sufentanil 1.5 μg·kg-1.The VAS scores and Ramsay scores were recorded at 1 h (t1), 4 h (t2),8 h (t3), 12 h (t4), 24 h (t5) and 48 h (t6) postoperatively.Total analgesic consumption of PCIA pump and total need of remedial drugs, the incidences of postoperative dizziness, nausea and vomiting, and other adverse reactions during postoperative 48 h were also documented. Results Compared with group E, VAS scores at each time point postoperatively in group DS and group ES were lower (P<0.05);and total analgesic consumption of PCIA pump and total need of remedial drugs were also lower than group E(P<0.05);the incidence of vertigo, nausea and vomiting, dysphoria, drowsiness in group DS were higher(P<0.05);while only the incidence of nausea and vomiting in group ES was higher than group E (P<0.05).Compared with group DS, no statistical significances of VAS scores were found at each time point postoperatively between group DS and group ES (P>0.05);but total analgesic consumption of PCIA pump and the need of remedial drugs in group ES were lower (P<0.05);patients in group ES with lower incidence of respiratory depression, vertigo, dysphoria and drowsiness ( P< 0. 05 ). No statistical significances were found when comparing the Ramsay scores at each time point postoperatively among three groups (P>0.05). Conclusion Eptazocine hydrobromide combined with sufentanyl can effectively alleviate the postoperative pain in patients with TURP, reduce the consumption of postoperative analgesics and incidence of analgesic related adverse reactions.

Avaliação do efeito da cetamina associada à remifentanila na dor pós-operatória / Assessment of the effect of ketamine in combination with remifentanil on postoperative pain / Evaluación del Efecto de la Cetamina Asociada con el Remifentanilo en el Dolor Postoperatorio

JUSTIFICATIVA E OBJETIVOS: A associação de cetamina com remifentanila parece estar relacionada à analgesia de melhor qualidade e duração. O objetivo deste estudo foi avaliar se a cetamina associada à remifentanila promove melhora da analgesia pós-operatória. MÉTODO: Estudo prospectivo, aleatório, duplo encoberto em 40 pacientes submetidos à colecistectomia videolaparoscópica. A anestesia foi feita com remifentanila, propofol, atracúrio, 50% de oxigênio. Os pacientes do G1 receberam remifentanila (0,4 mcg.kg-1.min-1) e cetamina (5 mcg.kg-1.min-1); os do G2, remifentanila (0,4 mcg.kg-1.min-1) e solução salina. Foi administrado 0,1 mg.kg-1 de morfina no final da operação e a dor pós-operatória foi tratada com morfina, através de analgesia controlada pelo paciente (PCA). A intensidade da dor pós-operatória foi avaliada pela escala numérica de 0 a 10, durante 24 horas. Foram anotados o tempo para primeira complementação analgésica, a quantidade de morfina usada durante 24 horas e os efeitos adversos. RESULTADOS: Ocorreu diminuição da intensidade da dor entre a desintubação e os outros momentos avaliados no G1 e no G2. Não foi observada diferença significante na intensidade da dor entre os grupos. Não houve diferença entre G1 (22 ± 24,9 min) e G2 (21,5 ± 28,1 min) no tempo para a primeira dose de morfina e dose complementar de morfina consumida no G1 (29 ± 18,4 mg) e no G2 (25,1 ± 13,3 mg). CONCLUSÕES: A associação de cetamina (5 mcg.kg-1.min-1) a remifentanila (0,4 mcg.kg-1.min-1) para colecistectomia não alterou a intensidade da dor pós-operatória, o tempo para primeira complementação ou a dose de morfina em 24 horas.

BACKGROUND AND OBJECTIVES: The combination of ketamine and remifentanil seems to be associated with better analgesia and duration. The aim of this study was to evaluate whether a ketamineremifentanil combination promotes improved postoperative analgesia. METHODS: Prospective, randomized, double blind study of 40 patients undergoing video laparoscopic cholecystectomy. Anesthesia was performed with remifentanil, propofol, atracurium, and 50% oxygen. Group 1 (GI) patients received remifentanil (0.4 mcg.kg-1.min-1) and ketamine (5 mcg.kg-1.min-1) and Group 2 (G2) received remifentanil (0.4 mcg.kg-1.min-1) and saline solution. Morphine 0.1 mg.kg-1 was administered at the end of the procedure, and postoperative pain was treated with morphine via PCA. We evaluated the severity of postoperative pain by a numerical scale from zero to 10 during 24 hours. We registered the time to the first analgesic supplementation, amount of morphine used in the first 24 hours, and adverse effects. RESULTS: There was a decrease in pain severity between extubation and other times evaluated in G1 and G2. There was no significant difference in pain intensity between the groups. There was no difference between G1 (22 ± 24.9 min) and G2 (21.5 ± 28.1 min) regarding time to first dose of morphine and dose supplement of morphine consumed in G1 (29 ± 18.4 mg) and G2 (25.1 ± 13.3 mg). CONCLUSION: The combination of ketamine (5 mcg.kg-1.min-1) and remifentanil (0.4 mcg.kg-1.min-1) for cholecystectomy did not alter the severity of postoperative pain, time to first analgesic supplementation or dose of morphine in 24 hours.

JUSTIFICATIVA Y OBJETIVOS: La asociación de la cetamina con el Remifentanilo parece estar asociada con una analgesia de mejor calidad y duración. El objetivo de este estudio fue evaluar si la cetamina asociada al Remifentanilo genera una mejoría de la analgesia postoperatoria. MÉTODO: Se hizo un estudio prospectivo, aleatorio y doble ciego en 40 pacientes sometidos a la colecistectomía videolaparoscópica. La anestesia se realizó con de Remifentanilo, propofol, atracurio y 50% de oxígeno. Los pacientes del G1 recibieron Remifentanilo (0,4 mcg.kg-1.min-1) y cetamina (5 mcg.kg-1.min-1); los del G2, Remifentanilo (0,4 mcg.kg-1.min-1) y solución salina. Fue administrado 0,1 mg.kg-1 de morfina al final de la operación y el dolor postoperatorio se trató con morfina por medio de analgesia controlada por el paciente (PCA). La intensidad del dolor postoperatorio fue mensurada por la escala numérica de 0 a 10, durante 24h. Se anotó el tiempo para la primera complementación analgésica, la cantidad de morfina utilizada durante 24 h y los efectos adversos. RESULTADOS: Ocurrió una reducción de la intensidad del dolor entre el momento de la desentubación y los otros momentos calculados en el G1 y en el G2. No fue observada ninguna diferencia significativa en la intensidad del dolor entre los grupos. No hubo diferencia entre G1 (22 ± 24,9 min.) y G2 (21,5 ± 28,1 min.) en el tiempo para la primera dosis de morfina y dosis complementaria de morfina consumida en el G1 (29 ± 18,4 mg) y en el G2 (25,1 ± 13,3 mg). CONCLUSIONES: La asociación de la cetamina (5 mcg.kg-1.min-1) con el Remifentanilo (0,4 mcg.kg-1.min-1) para la colecistectomía no alteró la intensidad del dolor postoperatorio, el tiempo para la primera complementación o la dosis de morfina en 24h.

Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho / Analgesic efficacy of the intra-articular administration of high Doses of morphine in patients undergoing total knee arthroplasty / Eficacia analgésica del uso de dosis alta de morfina intra-articular en pacientes sometidos a la artroplastia total de rodilla

Justificativa e objetivos: Apesar da eficácia da morfina intraarticular (IA) permanecer controversa, tem-se mostrado que doses maiores promovem melhores resultados e, consequentemente, menor consumo pós-operatório de analgésico, caracterizando, assim, efeito dose-dependente na ação periférica. Foi conduzido estudo controlado, aleatório e duplamente encoberto para avaliar a eficácia de 10 mg de morfina por via intra-articular em pacientes submetidos à artroplastia total de joelho. Método: Foram avaliados 50 pacientes submetidos à artroplastia total de joelho, distribuídos aleatoriamente em dois grupos: o grupotratamento recebeu 10 mg (1 mL) de morfina por via intra-articular diluído em 19 mL de solução fisiológica a 0,9 por cento (SF), enquanto o grupo-controle recebeu injeção intra-articular contendo 20 mL de SF, ambos após o fechamento da cápsula articular, ao final da operação. Morfina subcutânea sob demanda esteve disponível para dor residual. As seguintes variáveis foram avaliadas: intensidade da dor graduada na Escala Numérica (EN) às 2 h (M1), 6 h (M2), 12 h (M3) e 24 h (M4) após injeção IA; tempo para primeira solicitação de analgésico; consumo de analgésicos e efeitos adversos. Conclusões: O grupo-tratamento apresentou menores valores na EN que o grupo-controle em M1 e M2, enquanto que nos outros momentos não houve diferença significativa. O intervalo para primeira solicitação de analgésicos foi significativamente maior no grupo tratamento e o consumo de analgésicos nas primeiras 24 horas foi menor neste grupo. Não houve diferença entre incidência de efeitos adversos entre os grupos. Concluiu-se que 10 mg de morfina reduziram dor pós-operatória 2 e 6 horas após injeção IA, promoveram maior período sem analgésico de resgate e reduziram seu consumo nas primeiras 24 horas.

Background and objectives: Although the efficacy of intraarticular (IA) morphine is still controversial, it has been shown that higher doses promote better results and consequently decrease postoperative analgesic consumption, characterizing a dose-dependent peripheral action. A controlled, randomized, double-blind study was undertaken to evaluate the efficacy of the intra-articular administration of 10 mg of morphine in patients undergoing total knee arthroplasty. Methods: Fifty patients undergoing total knee arthroplasty were randomly divided into two groups: the treatment group received 10 mg (1 mL) of intra-articular morphine diluted in 19 mL of NS, while the control group received the intra-articular administration of 20 mL of NS, both after closure of the capsule at the end of the surgery. On demand subcutaneous morphine was available for residual pain. The following parameters were evaluated: pain severity according to the numeric scale (NS), 2 h (M1), 6 h (M2), 12 h (M3), and 24 h (M4) after the IA injection; time until the first request of analgesic; analgesic consumption, and side effects. Conclusions: The treatment group had lower NS than the control group in M1 and M2, while significant differences were not observed in the other moments. The time until the first request of analgesics was significantly higher in the treatment group, and analgesic consumption in the first 24 hours was also lower in this group. The incidence of side effects did not differ between both groups. We concluded that the postoperative IA administration of 10 mg of morphine promoted a longer period without rescue analgesics and reduced their consumption in the first 24 hours.

Justificativa y objetivos: A pesar de que la eficacia de la morfina intra-articular (IA), permanece como algo controvertido, ha quedado demostrado que las dosis mayores generan mejores resultados y consecuentemente, un menor consumo postoperatorio de analgésico, caracterizando así, el efecto dosis-dependiente en la acción periférica. Fue realizado un estudio controlado, aleatorio y doble ciego para evaluar la eficacia de 10 mg de morfina por vía intraarticular en pacientes sometidos a la artroplastia total de rodilla. Método: Se evaluaron 50 pacientes sometidos a la artroplastia total de rodilla, distribuidos aleatoriamente en dos grupos: el grupo tratamiento recibió 10 mg (1 mL) de morfina por vía intra-articular diluido en 19 mL de solución fisiológica al 0,9 por ciento (SF), mientras que el grupo control recibió una inyección intra-articular con 20 mL de SF, ambos después del cierre de la cápsula articular, al final de la operación. La morfina subcutánea bajo demanda, estuvo disponible para el dolor residual. Se evaluaron las siguientes variables: intensidad del dolor graduada en la Escala Numérica (EN) a las 2h (M1), 6h (M2), 12h (M3) y 24h (M4), después de la inyección IA; tiempo para la primera solicitación de analgésico; y consumo de analgésicos y efectos adversos. Conclusiones: El grupo tratamiento presentó menores valores en la EN que el grupo control en M1 y M2, mientras que en los otros momentos, no se registró ninguna diferencia significativa. El intervalo para la primera solicitación de analgésicos fue significantemente mayor en el grupo tratamiento y el consumo de analgésicos en las primeras 24 horas fue menor en ese grupo. No hubo diferencia entre la incidencia de efectos adversos entre los grupos. Llegamos a la conclusión, de que 10 mg de morfina redujeron el dolor del postoperatorio entre 2 y 6 horas después de aplicada la inyección IA, y se generó un periodo mayor sin analgésico de rescate reduciendo su consumo en las...

Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal / Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal / Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

Justificativa e objetivos: O procedimento de correção de pé torto congênito (PTC) cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças...

Background and objetives: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children...

Justificativa y objetivos: El procedimiento de corrección depie jorobado congénito (PJC), debuta con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección...

Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril / Efectos de la analgesia epidural y del bloqueo continuo del plexo lumbar sobre la rehabilitación funcional después de la artroplastia total de cadera / Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

JUSTIFICATIVA E OBJETIVOS: A dor após artroplastia total do quadril (ATQ) é intensa e agravada pelas mobilizações, o que demanda técnica analgésica eficaz e que permita mobilidade precoce, participação nas atividades de reabilitação e rápida recuperação funcional. O objetivo do estudo foi comparar os efeitos das técnicas de analgesia controlada pelo paciente (ACP) pelas vias peridural e perineural do plexo lombar sobre a reabilitação funcional em pacientes submetidos à ATQ. MÉTODO: Pacientes estado físico ASA I a III foram alocados aleatoriamente nos grupos Peridural e Lombar. Para a ATQ, foi realizada anestesia peridural lombar contínua com ropivacaína a 0,5 por cento (Peridural) ou bloqueio contínuo do plexo lombar com ropivacaína a 0,5 por cento (Lombar). Na sala de recuperação, iniciou-se ACP com infusão de ropivacaína a 0,2 por cento (Lombar) ou ropivacaína a 0,2 por cento + fentanil 3 µg.mL-1 (Peridural). A eficácia da analgesia nas primeiras 48 horas após a ATQ (escores de dor, consumo de morfina de resgate e de bolos da bomba de ACP) foi comparada entre os grupos. Diferentes parâmetros da reabilitação pós-operatória foram estudados. RESULTADOS: Quarenta e um pacientes foram submetidos à análise estatística. Os escores de dor em repouso foram semelhantes nos dois grupos. Apesar do controle mais efetivo da dor dinâmica no grupo Peridural e o uso de morfina ter sido maior, mais frequente e mais precoce no grupo Lombar, não houve diferença entre os grupos em nenhum dos parâmetros estudados de reabilitação. As técnicas de analgesia não influenciaram as falhas no processo de reabilitação. CONCLUSÕES: A maior efetividade da analgesia peridural não se traduziu em melhora no processo de reabilitação, nem reduziu o tempo necessário para alcançar os desfechos estudados.

BAKGROUND AND OBJECTIVES: Pain after total hip arthroplasty (THA) is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation in rehabilitation activities, and fast functional recovery. The objective of this study was to compare the effects of epidural and perineural patient-controlled analgesia (PCA) of the lumbar plexus on functional rehabilitation of patients undergoing THA. METHODS: Patients classified as physical status ASA I to III were randomly divided into two groups: Epidural and Lumbar. For THA, patients underwent continuous epidural lumbar block with 0.5 percent ropivacaine (Epidural) or continuous lumbar plexus block with 0.5 percent ropivacaine (Lumbar). In the recovery room, PCA with infusion of 0.2 percent ropivacaine (Lumbar) or 0.2 percent ropivacaine + fentanyl 3 µg.mL-1 (Epidural) was instituted. Analgesic efficacy in the first 48 hours after THA (pain scores, rescue morphine consumption, and bolus of the PCA pump) was compared between both groups. Different postoperative rehabilitation parameters were analyzed. RESULTS: Forty-one patients underwent statistical analysis. Resting pain scores were similar in both groups. Despite more effective control of dynamic pain in the Epidural group and the greater, more frequent, and earlier morphine consumption in the Lumbar group, rehabilitation parameters evaluated did not differ in both groups. Analgesia techniques did not affect rehabilitation failures. CONCLUSIONS: The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals.

JUSTIFICATIVA Y OBJETIVOS: El dolor después de la artroplastia total de la cadera (ATC) es intenso y se agrava por los movimientos, lo que demanda una técnica analgésica eficaz y que permita la movilidad precoz, la participación en las actividades de rehabilitación, y una rápida recuperación funcional. El objetivo de este estudio, fue comparar los efectos de las técnicas de analgesia controlada por el paciente (ACP), por las vías epidural y perineural del plexo lumbar sobre la rehabilitación funcional en pacientes sometidos a la ATC. MÉTODO: Pacientes en estado físico ASA I a III, que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. Para la ATC, se realizó la anestesia epidural lumbar continua con ropivacaína a 0,5 por ciento (Epidural) o bloqueo continuo del plexo lumbar con ropivacaína a 0,5 por ciento (Lumbar). En la sala de recuperación, se inició ACP con infusión de ropivacaína a 0,2 por ciento (Lumbar) o ropivacaína a 0,2 por ciento + fentanil 3 µg.mL-1 (Epidural). La eficacia de la analgesia en las primeras 48 horas después de la ATC (niveles de dolor, consumo de morfina de rescate y de bolos de la bomba de ACP), se comparó entre los grupos. Los diferentes parámetros de la rehabilitación postoperatoria también se estudiaron. RESULTADOS: Cuarenta y un pacientes se sometieron al análisis estadístico. Los niveles de dolor en reposo fueron similares en los dos grupos. A pesar de un control más efectivo del dolor dinámico en el grupo Epidural y de un uso más potente de la morfina, que se aplicó más a menudo y precozmente en el grupo Lumbar, no hubo diferencia entre los grupos en ninguno de los parámetros estudiados de rehabilitación. Las técnicas de analgesia no influyeron en las fallas en el proceso de rehabilitación. CONCLUSIONES: El más alto nivel de efectividad de la analgesia epidural, no se tradujo en una mejoría en el proceso de rehabilitación, ni tampoco redujo el tiempo necesario para alcanzar los resultados estudiados.

Comparing the Effects between a Continuous Epidural Infusion of an Opioid or an Opioid-Local Anesthetic Mixture and a Continuous IV Infusion of an Opioid after a Spinal Laminectomy / 대한마취과학회지

BACKGROUND: Postoperative pain after a spinal laminectomy has very harmful effects on human physiology, and many people are trying to control it more easily and safely. There are controversies in methods used for controlling postoperative pain after a spinal laminectomy. The purpose of this study was to examine an effective way to control postoperative pain after a spinal laminectomy. METHODS: Ninety patients (ASA I-II, aged 40 to 70) scheduled for a spinal laminectomy were divided into three groups. In group A, we administered fentanyl 1,000 microgram and morphine 5 mg (mixed in 0.9% normal saline) using the continuous epidural infuser; in group B, we administered fentanyl 500 microgram and morphine 5 mg and 0.25% bupivacaine (mixed in 0.9% normal saline) using the continuous epidural infuser; in group C, we administered fentanyl 1,500 microgram and morphine 10 mg (mixed in 0.9% normal saline) using the continuous IV infuser. We compared effects between the continuous epidural infusion and the continuous intravenous infusion by using the visual analogue scale and side effects. RESULTS: There was no significant difference between continuous epidural infusion groups. When the continuous epidural infusion groups and the continuous IV infusion group were compared, there were significant differences in 3 hr, 6 hr, and 12 hr VAS scores (P < 0.01). The incidence of side effects was very low, and there was no significant difference in side effects between the continuous epidural infusion and the continuous IV infusion groups. CONCLUSIONS: It was found that continuous epidural infusion methods were more effective than the continuous IV infusion method, but none of them showed satisfactory postoperative pain control in the early periods.

The Comparison of Postoperative Analgesic Effect of Morphine-Bupivacaine and Morphine-Bupivacaine-Clonidine Injected Intraarticularly after Knee Arthroscopy / 대한마취과학회지

BACKGROUND: Intraarticular opioids and local anesthetics may provide effective analgesia following knee arthroscopic surgery. However, there are conflicting results about the analgesic effects of a combination of morphine, bupivacaine and clonidine injected intraarticularly following knee arthroscopic surgery. The goal of this study was to determine whether clonidine added to an intraarticular morphine- bupivacaine combination provide an analgesic benefit. METHODS: Thirty patients scheduled for knee arthroscopic surgery under epidural anesthesia were selected and divided to two groups randomly. The patients in Group 1 received a combination of morphine 3 mg 0.25% bupivacaine 30 ml and patients in Group 2 received a combination of clonidine 3microgram/kg and morphine 3 mg in 30 ml of 0.25% bupivacaine intraarticularly following knee arthroscopic surgery. Postoperative pain was assessed using the visual analogue scale (VAS) and changes of arterial blood pressure, heart rate, requirement of additional analgesics, adverse effects and sedation scale were observed at 1, 2, 4, 8 and 24 hours after intraarticular injection. RESULTS: The VAS observed at 4, 8 and 24 hours after intraarticular injection were significantly lower in group 2 than group 1. Blood pressure and heart rate were not significantly changed between group 1 and group 2. The incidence of side effects, injection of additional analgesics and sedation were similar between the groups. There were no significant differences in hemodynamic changes, analgesic requirements, sedation scale or the increase of side effects between group 1 and group 2. CONCLUSIONS: The results suggest that the combination of intraarticular morphine 3 mg in 30 ml 0.25% bupivacaine plus clonidine provides significantly better analgesia than morphine 3 mg in 30 ml 0.25% bupivacaine alone following knee arthroscopy.

Postoperative Analgesic Effect of Epidural Neostigmine Coadministered with Bupivacaine under General Anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal injection of analgesic agents such as opioids, clonidine, ketamine and nalbuphine with a local anesthetic produces analgesia in patients. Recently, the analgesic effect of intrathecal neostigmine has been investigated; however, the use of epidural neostigmine has not been investigated. The purpose of this study was to define the analgesic effectiveness and the side effects of epidural neostigmine. METHODS: Forty patients undergoing a total abdominal hysterectomy were divided into 4 groups. After intramuscular 0.1 mg/kg midazolam premedication, patients were randomized to receive epidural bupivacaine with saline (control group), 1 microgram/kg epidural neostigmine (Group I), 2 microgram/kg epidural neostigmine (Group II), or 3 microgram/kg epidural neostigmine (Group III) postoperatively. The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was introduced. Pain was assessed by using the visual analog scale at 1, 3, 6, 9, 12, and 24 h postoperatively, and intramuscular 90 mg diclofenac was available at the patient's request. RESULTS: The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among neostigmine groups. The analgesic consumption in 24 hours and the pain visual analog scale score at 3 h, 12 h, and 24 h were significantly decreased in neostigmine groups compared with control groups. CONCLUSIONS: Epidural neostigmine coadministered with bupivacaine produces a dose-independent analgesic effect compared to the control group and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.

The Effect of Pretreated Ketorolac on Postoperative Pain and the Satisfaction of Patients / 대한마취과학회지

BACKGROUND: Postoperative pain is the principal acute pain and many trials have been done for it. The preemptive analgesic method is one of the trials and nonsteroidal antiinflammatory drugs (NSAIDs) have been under study to reduce the side effects of opioids and to gain some other advantages, and many positive results have been reported. The author therefore planned this study to evaluate whether or not NSAIDs could have a preemptive effect, to observe any difference in effect with increasing dose, and to identify any advantage to patients under preemptive analgesia. METHODS: Seventy-five patients undergoing open cholecystectomy or choledochocystostomy were randomly allocated into three groups, group K0, K30 and K60. In group K0 (n = 25), patients were given no medication before operation. In groups K30 and K60, patients were given ketorolac 30 mg and 60 mg by intravenous route at 15 minutes before operation respectively. After operation, one observer who didn't know which group the patients were allocated to recorded patients' pain score (visual analogus scale; VAS and Prince-Henry score; PHS), side effects and satisfactory score at postpoperative 0, 1, 6, 12, 24 and 48 hours. For VAS > 50 or PHS > 3, morphine 2.5 mg was given by intravenous route and pain score was reestimated after 10 minutes and this was repeated until VAS < 50 and PHS < 3. RESULTS: In group K60, VAS, PHS and dose of morphine were lower than in other groups (p < 0.05). Satisfaction score was higher in group K60 and the nurse's satisfaction score was higher than the patient's in group K0 and K30 (p < 0.05). There was no significant difference in hospital days between groups. Side effects were negligible. CONCLUSIONS: Preoperative intravenous administration of ketorolac 60 mg in open cholecystectomy or choledochocystostomy could have a preemptive analgesic effect and give more satisfaction to patients. In the immediate postoperative period, pain status may be highest, so more attention and evaluation will be needed by pain management staffs for the proper management of acute pain.

The Preemptive Analgesic Effect of Bupivacaine Infiltration on Postoperative Pain after Inguinal Herniorrhaphy / 대한마취과학회지

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.

A Comparison of Epidural 0.2% Ropivacaine Alone and in Combination with 4 microgram/ml Fentanyl for Postoperative Analgesia after Total Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Epidural infusions usually comprise a local anesthetic, an opioid, or more commonly, a combination of the two, to minimize individual doses and to reduce unwanted side effects. The aim of this study was to compare analgesic and side effects of epidural infusion with 0.2% ropivacaine alone and in combination with 4 microgram/ml fentanyl after total abdominal hysterectomy. METHODS: Forty healthy total abdominal hysterectomy patients under general anesthesia with postoperative analgesia by continuous epidural infusion were randomly allocated into Group I; 0.2% ropivacaine alone (n = 20) or Group II; 0.2% ropivacaine and 4 microgram/ml fentanyl (n = 20). We assessed the visual analogue scale (VAS, 0 = no pain, 10 = worst pain), frequency of supplemental analgesics, side effects and patients' satisfaction of the result. RESULTS: The VAS and the frequency of supplemental analgesics were significantly lower and fewer in Group II compared to Group I. The incidence and severity of side effects were no differences between two groups. The satisfactions of patients were significantly higher in Group II. CONCLUSIONS: For postoperative analgesia, the epidural infusion of 0.2% ropivacaine with 4 microgram/ml fentanyl provided better analgesia than 0.2% ropivacaine alone.

Intravenous Regional Anesthesia Using Mepivacaine and Clonidine / 대한마취과학회지

BACKGROUND: The alpha2-adrenergic agonist clonidine has been extensively studied as an adjunct to general and regional anesthesia. Clonidine has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The purpose of this study was to evaluate the effectiveness of that using clonidine as a component of intravenous regional anesthesia (IVRA) to enhance postoperative analgesia. METHODS: Thirty-six patients undergoing hand surgery received IVRA with mepivacaine 0.5%, and were assigned randomly and blindly to one of the following groups as follows: Group I (n = 12) received only mepivacaine. Group II (n = 12) was given 0.5 microgram/kg clonidine as part of the IVRA solution. Group III (n = 12) received 1.0 microgram/kg clonidine as part of the IVRA solution. After the end of the operations, the analgesic effects were evaluated by using the visual analogous scale (0-10). Sedation scores (0-3), supplemental analgesic use, and side effects were also evaluated. RESULTS: The patients who received IVRA with 1.0 microgram/kg clonidine reported significantly lower pain score after tourniquet deflation compared with other groups, and a decreased need for analgesic in the postanesthesia care unit. No significant postoperative sedation, hypotension, or bradycardia developed in any of the patients. CONCLUSIONS: The addition of 1.0 microgram/kg clonidine to mepivacaine 0.5% for IVRA provided improved analgesia in the postanesthesia care unit after the operation and decreased the need for analgesic supplements after the operation.

Analgesic Effect of Epidural Clonidine after Cesarean Section / 대한마취과학회지

BACKGROUND: The importance of the intrinsic analgesic properties of the alpha 2-agonist is difficult to establish, but many studies have shown the beneficial effect of epidural clonidine in postoperative pain management. The authors examined the analgesic effect of clonidine, a preferential alpha 2-adrenergic agonist, upon hemodynamics, and side effects during the post-operative period in patients undergoing Cesarean section. METHODS: Sixty healthy parturients undergoing Cesarean section with general anesthesia were divided into two groups as follows: 1) Epidural Morphine group: An initial dose of morphine 3 mg diluted with 10 ml of 0.125% bupivacaine was injected epidurally at time of the peritoneal closure, followed by a continuous epidural infusion of morphine 7 mg and 100 ml of normal saline for the postoperative 2 days. 2) Epidural Clonidine group: An initial dose of clonidine 150 microgram diluted with 10 ml of 0.125% bupivacaine was injected epidurally at time of the peritoneal closure, followed by a continuous epidural infusion of clonidine 1800 microgram and 100 ml of normal saline for the postoperative 2 days. Postoperative analgesia was assessed by recording the VAS (Visual Analogue Scale), PHS (Prince Henry Score) at postoperative 1, 2, 3, 6, 12, 24, and 48 hours. Blood pressure, heart rate, sedation, and side effects were also recorded. RESULTS: There were no statistically significant differences in the VAS and hemodynamic changes between the two groups, but the epidural clonidine reduced the PHS significantly at 1, 2, 3 postoperative hours (P < 0.05). There were less side effects in the cases of epidural clonidine as compared with epidural morphine. CONCLUSION: In comparison to epidural morphine, epidural clonidine produces a similar degree of analgesia but less side effects.

Analgesic Effect and Adverse Effects of Intrathecal Neostigmine Used in Spinal Anesthesia for Orthopedic Surgery / 대한마취과학회지

BACKGROUND: Intrathecal injection of analgesic agents sush as opioids, clonidine, ketamine and nalbuphine with a local anesthetic agent during spinal anesthesia for operation is an easy and convenient way to get postoperative analgesia. Intrathecal neostigmine causes an increased ACh concentration in CSF and also has an analgesic effect. This study was designed to examine its postoperative analgesic effect and adverse effects such as nausea/vomiting and urinary retention etc. METHODS: We divided 27 patients who were supposed to receive orthopedic surgery of lower extremities into 3 groups. The control group as injected with heavy bupivacaine 13 mg and normal saline and the N50 and N75 groups were injected with the same amount of bupivacaine combined with neostigmine 50 mcg and 75 mcg respectively. We examined total amount of fluid intake and side effects during operation, and time to first rescue analgesic medication, time to first urination, total applications of rescue analgesic agent, total number of urinary catheterizations for 24 hr after intrathecal injection, and adverse effects of intrathecal neostigmine in the ward. RESULTS: The N75 group showed a significantly longer analgesic duration compared with the control and N50 groups, but the incidence of urinary retention and number of urinary catheterizations increased in the N75 group significantly. Nausea/Vomiting significantly increased in N75 compared with control. Shivering was more common in N50. 2 patients who recieved neostigmine 75 mcg complained of chest discomforts suggesting myocardial ischemia in EKG taken in those episodes. CONCLUSIONS: Neostigmine 75 mcg has better analgesic effect but more frequent adverse effects than control or neostigmine 50 mcg. Therefore, we suggest using high doses of neostigmine cautiously and being aware of its side effects.

The Effects of Anesthetic Techniques and Postoperative Pain Control on the Response of the Stress and Immune System in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Surgical trauma may affect the host immune system. We have examined the time course of circulating interleukin-6 (IL-6) and cortisol in patients undergoing a cesarean section (c/s) to determine if the anesthetic techniques and postoperative pain control have an effect on the response of the stress and immune system. METHODS: Thirty healthy women undergoing c/s were randomly allocated to three groups. Group I (n = 10) was provided with general anesthesia, group II (n = 10) with epidural anesthesia and group III (n = 10) with epidural anesthesia plus continuous epidural analgesia for postoperative pain control. Blood samplings for IL-6 and cortisol were conducted 4 times in all patients: preoperation, 1 h, 3 h and 24 h after skin incision. RESULTS: The mean concentrations of IL-6 were significantly increased in all three groups at 3 h and 24 h after the skin incision, but there were no significant differences among the three groups. The mean concentrations of cortisol were significantly increased in three groups at 1 h and 3 h after the skin incision, but there were no significant differences among the three groups. CONCLSIONS: No significant differences among three groups were seen. Thus, We couldn't determine that anesthetic techniques and postoperative pain control had a significant effect on the response of the stress and immune system.