Ultrasound-guided lumbar erector spinae plane block versus caudal block for postoperative analgesia in pediatric hip and proximal femur surgery: a randomized controlled study / 대한마취과학회지

Background@#According to previous research, 20% of infants experience prolonged postsurgical pain 6–12 months after major surgery, which is linked to functional impairment and a lower quality of life. The aim of our study is to evaluate whether the analgesic effect of the erector spinae plane block (ESPB) is superior to that of caudal epidural anesthesia (CEA) in pediatric patients undergoing hip or proximal femoral surgeries. @*Methods@#Seventy-six children ranging in age from 1 to 7 years scheduled for hip or proximal femur surgery were randomly assigned to receive either a unilateral ultrasound-guided ESPB or CEA with bupivacaine 0.25% at a dose of 0.5 ml/kg. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) scale 2 h postoperatively. The secondary outcomes were pain scores every 15 min for the first hour and then at 6, 12, and 24 h postoperatively; the block failure rate; time to perform a successful block; and time to first rescue analgesia. @*Results@#The FLACC score 2 h post¬operatively was not superior in the ESPB group compared to the CEA group; indeed, it was significantly higher in the ESPB group at 15 and 30 min post-operation (P = 0.005, 0.004, respectively). Additionally, the time to first rescue analgesia was prolonged in the CEA group (P < 0.001). The time to perform a successful block was comparable between the groups. @*Conclusions@#The analgesic effect of the ESPB was not superior to that of CEA in pediatric patients undergoing hip and proximal femur surgery.

Comparative study of different doses and routes of administration of lornoxicam for peri-operative analgesia in patients undergoing intravenous regional anesthesia for minor upper arm surgery

The use of perioperative NSAIDs has become popular in operation ranging from minor outpatient to major inpatient surgery. A systemic review suggested that NSAIDs have the most to offer as adjuncts to intravenous regional anesthesia. Lornoxicam has demonstrated clinical efficacy in relieving pain, through different routes of administrations, oral, IM, IV, and local infiltration. In this study comparison of different doses and routes of administration of Lornoxicam for peri-operative analgesia in patients undergoing intravenous regional anesthesia for minor upper arm surgery was done. 60 patients ASA 1 and 2 undergoing minor upper limb surgeries were studied Patients were randomly divided into six groups; Group I: Total volume of 40ml of pre-prepared Local intravenous solution mixed with 8mg of Lornoxicam. Group 2: Total volume of 40ml of pre-prepared Local intravenous solution mixed with 16mg of Lornoxicam. Group 3: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 8mg intramuscular. Group 4: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 16mg intramuscular. Group 5: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 8mg intravenously. Group 6: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 16mg intravenously. Better qualities of block, less tourniquet pain, and better quality of postoperative analgesia were found in groups 1, 2 that had lornoxicam combined with lidocaine compared with other groups used lornoxicam intravenously or intramuscular [p<0.05]. Moreover, using lornoxicam 16mg proved to be better than lornoxicam 8mg when combined with total intravenous solution [p<0.05]. Lornoxicam used in the local intravenous solution gave better quality of intraoperative condition and postoperative analgesia without increase in the incidence of side effects compared with lornoxicam used intramuscularly or intravenously. Also lornoxicam 16mg provide better intraoperative analgesia compared to lornoxicam 8mg when both were used locally with local intravenous regional analgesia

influence of two different hydroxyethyl starch solutions [6 % HES 130/0.4 and 200/0.5] on postoperative pulmonary functions in patients undergoing elective abdominal aortic surgery

Major surgery may alter the physiologic immune balance and initiate systemic inflammatory processes which may progress to severe postoperative complication e.g. multiple organ dysfunction syndrome [MODS] or adult respiratory distress syndrome [ARDS]. The colloid used for intra vascular volume replacement in surgical patients may affect the inflammatory response during major surgery. Thirty six patients scheduled for elective abdominal aortic aneurysm surgery were randomized to receive either 6% hydroxyethly starch HES 200/0.5 or 6% hydroxyethyl starch HES 130/0.4 for colloid replacement. Lung function was assessed with PO[2]/FiO[2]ratio, respiratory compliance, chest X-ray and a score for lung injury. Serum concentrations of interleukin [IL]-6, IL-8 and IL-10 were measured. After aortic cross clamp release the PO[2]/FiO[2] ratio was 354.6 +/- 7.95 mmHg for the HES 130/0.4 compared with318 +/- 9.52 mmHg for the HES 200/0.5 treated patients. Twelve hours after aortic cross clamp release, PO[2]/FiO[2]ratio for the HES 130/0.4 patients was 316 +/- 9.04 compared with 259.44 +/- 6.92 for HES 200/0.5 patients [p<0.001]. In the first postoperative day it was 251.6 +/- 4.2 for HES 130/0.4 patients compared with 217 +/- 9.74 for HES 130/0.4 treated patients. Respiratory compliance was greater for HES 200/0.5 treated patients compared with HES 130/0.4 treated patients. Peak values of IL-6 and IL-8 were significantly lower in HES 200/0.5 treated patients compared with HES 130/0.4 treated patients serum IL-6 were 52.9 +/- 10.2pg/dl in HES 200/0.5 group compared with 46 +/- 11.8pg/dl for HES 130/0.4 group serum IL-8 were 45 +/- 8.9pg/ml in HES 200/0.5 group compared with 37 +/- 9.8pg/ml in HES 130/0.4 group. Intravascular volume replacement with HES 130/0.4 resulted in better perioperative pulmonary function and reduced inflammatory response in patients undergoing abdominal aortic surgery compared with HES 200/0.5

Hyperbaric bupivacaine and fentanyl for elective cesarean section: effect of a height and weight adjusting dose

There are large varieties of dosage regimens which are in use for spinal anesthesia for Cesarean section [3]. All aiming for limiting the dose of Bupivacaine to reduce incidence of maternal hypotension and vasopressor requirements, decreasing nausea and vomiting, reducing time to discharge from post anesthesia unit, and improving maternal satisfaction [4]. This study was designed to assess the validity of adjusting the dosage of intrathecal hyperbaric bupivacaine according to the patient's height and weight would provide adequate surgical anesthesia for elective cesarean section while decreasing the incidence of maternal hypotension and the use of vasopressor to treat hypotension and consequently fetal outcome. Patients were randomly assigned to be involved into two groups. Group 1: The fixed dose group, patients received fentanyl 20 microgram [0.4ml] added to hyperbaric bupivacaine 0.5% 2.4ml. Group 2: The adjusting dosage group, patients receive fentanyl 20 microgram [0.4ml] added to a volume of hyperbaric bupivacaine 0.5% that is determined by referencing to the dosage regimen detailed Table. All the cardiovascular data measured plus the incidence of nausea and vomiting were statistically significantly lower in the adjusted group compared to the fixed one [p<0.05]. Time to loss of cold [T4] and to pinprick sensation to T64 on both sides were significantly slower in the adjusted group [p<0.05]. There were no significant differences as regard the visual analogue scale, number of patients needed supplementary analgesia, or the fetal outcome between the two groups at different time intervals [p>0.05]. Adjusting the intrathecal hyperbaric Bupivacaine dose to patient's height and weight combined with 20 microgram Fenatnyl provide adequate anesthesia with less maternal side effects for patients undergoing elective cesarean section

Rocuronium and cisatracurium induced neuromuscular block in phenytoin treated rats

Phenytoin is a widely used anticonvulsant drug, the chronic administration of which maybe associated with several drug interactions. This study aims at testing the presence of an interaction between phenytoin and two of the newly used neuromuscular b lockers [NMBs], namely rocuronium and cisatracurium. 96 male albino rats were used, half of which were treated daily with oral phenytoin, 100 mg/Kg for four weeks, while the rest were given the vehicle and served as controls. Thirty six animals from each group were used for in vivo administration of three different doses of each tested neuromuscular blacker [0.5, 1.0 and 2.0 mg/Kg in case of rocuronium and 0.4, 0.8 and 1.6 mg/Kg in case of cisatracurium] and twelve were used to obtain phrenic nerve diaphragm preparations for evaluation of in vitro actions of different concentrations of the tested NMBs [0.25, 0.5 and 1.0 micro g/Kg in case of rocuronium and 0.5, 1.0 and 2.0 micro g/Kg in case of cisatracurium]. With both NMBs, there was a significantly shorter duration of paralysis and a significantly shorter recovery index following phenytoin treatment. This was true for all studied doses. The effect of all tested concentrations of rocuronium and cisatracurium on the response to phrenic nerve stimulation was significantly less in preparations obtained from phenytoin treated animals with an almost parallel rightward shift of concentration response curves. Results of this study suggest a dynamic background for the resistance commonly encountered with NMBs among patients on chronic phenytoin therapy. A kinetic type of interaction, however can not be excluded. It is thus recommended that more frequent or continuous monitoring should be considered in patients known to be on chronic anticonvulsant therapy even those receiving NMBs like cisatracurium, with a predominantly organ-independent elimination

Cardiorespiratory effects and systemic stress response of abdominal laparoscopic procedures in children: comparison with conventional laparotomy

In this study, 30 children aged 1.5-14 years were assigned to undergo laparoscopy or laparotomy with a standard anesthetic technique. Heart rate and mean arterial pressure were monitored at different time intervals. An intra-arterial cannula was inserted. From blood gases, arterial partial pressure of CO2[PaCO2], O2 saturation [SaO2] and pH were measured at five min. after induction [T0], 15 min. into surgery [T15], 30 min. into surgery [T30], at end of surgery prior to extubation [T end] and following extubation [T ext]. Blood prolactin, cortisol, glucose, insulin and interleukin-6 levels were determined at five min. after induction of anesthesia [T0], 30 min. into surgery [T30] and at the end of surgery [T end]. It was concluded that the surgical stress and trauma imposed by laparoscopy seems to be similar to that caused by laparotomy in children undergoing elective abdominal surgery