Addition of lidocaine to levobupivacaine reduces intrathecal block duration: randomized controlled trial / Adição de lidocaína à levobupivacaína reduz a duração do bloqueio intratecal: estudo clínico randômico / La adición de lidocaína a la levobupivacaína reduce la duración del bloqueo intratecal: estudio clínico aleatorizado

Background: The duration of the spinal block is a concern for anesthetists. Low dose intrathecal lidocaine has vasodilatory effects and increases the local anesthetic clearance from the intrathecal space. The aim was to investigate whether this effect of lidocaine can be used to increase the resolution of levobupivacaine spinal anesthesia. Method: After obtaining ethical approval and informed patient consent, 40 patients underwent transurethral prostate resection were studied. Patients were randomized into two groups and patients received either levobupivacaine 6.75 mg + 0.3 mL 2% lidocaine (Group L) or levobupivacaine 6.75 mg + saline (Group C). The main outcome measures were the difference between groups regarding the duration of the spinal block and PACU stay. Secondary outcome measures were the difference between groups in onset and resolution of the spinal block, adverse events and treatments were also investigated. Results: Spinal block resolved faster in Group L than Group C; 162.43 ± 39.4 min vs 219.73 ± 37.3 min (p = 0.000). PACU time was shorter in Group L (109 ± 49.9 min in Group L vs 148 ± 56.8 min in Group C) (p = 0.036). There was no difference between groups with respect to the incidence of adverse events and treatments. Groups were also similar regarding complications. PDPH and TNS were not observed in any group. Conclusion: Addition of low dose lidocaine to hyperbaric levobupivacaine reduces the duration of the intrathecal block provided by hyperbaric levobupivacaine. This technique can be used to reduce the spinal block duration for relatively short procedures like TUR-P. .

Justificativa e objetivo: a duração do bloqueio espinhal é uma preocupação para os anestesistas. Lidocaína intratecal em dose baixa tem efeito vasodilatador e aumenta a eliminação do anestésico local do espaço intratecal. O objetivo deste estudo foi analisar se esse efeito da lidocaína pode ser usado para aumentar a resolução da anestesia espinhal com levobupivacaína. Método: após obter aprovação do Comitê de Ética e consentimento informado, 40 pacientes submetidos à ressecção transuretral da próstata foram incluídos no estudo. Os pacientes foram randomizados em dois grupos e receberam6mgde levobupivacaína + 0,3 mL de lidocaína a 2% (Grupo L) ou6,75mgde levobupivacaína + solução salina (Grupo C). O desfecho primário foi a diferença entre os grupos em relação à duração do bloqueio espinhal e a permanência na sala de recuperação pós-anestésica (SRPA). Os desfechos secundários foram a diferença entre os grupos em relação ao início e à resolução do bloqueio espinhal; eventos adversos e tratamentos também foram investigados. Resultados: a resolução do bloqueio espinhal foi mais rápida no Grupo L do que no Grupo C: 162,43 ± 39,4 min vs. 219 ± 37,3 min (p = 0,000). O tempo na SRPA foi menor no Grupo L do que no Grupo C: 109 ± 49,9 min vs. 148 ± 56,8 min (p = 0,036). Não houve diferença entre os grupos em relação à incidência de eventos adversos e tratamentos. Os grupos também foram semelhantes no que diz respeito a complicações. Cefaleia pós-punção dural (CPPD) e sintomas neurológicos transitórios (SNT) não foram observados em nenhum grupo. Conclusão: a adição ...

Justificación y objetivo: la duración del bloqueo raquídeo es una preocupación para los anestesistas. La lidocaína intratecal en dosis baja tiene un efecto vasodilatador y aumenta la eliminación del anestésico local del espacio intratecal. El objetivo de este estudio fue analizar si ese efecto de la lidocaína puede ser usado para aumentar la resolución de la anestesia raquídea con levobupivacaína. Método: después de obtener la aprobación del Comité de Ética y el consentimiento informado del paciente, fueron incluidos en el estudio 40 pacientes sometidos a resección transuretral de próstata. Los pacientes fueron aleatorizados en 2 grupos y recibieron 6 mg de levobupivacaína + 0,3 mL de lidocaína al 2% (grupo L) o 6,75 mg de levobupivacaína + solución salina (grupo C). El objetivo primario fue analizar la diferencia entre los grupos con relación a la duración del bloqueo raquídeo y la permanencia en la sala de reanimación postanestesia. El secundario fue la diferencia entre los grupos con relación al inicio y al término del bloqueo raquídeo. También se investigaron los eventos adversos y los tratamientos. Resultados: la resolución del bloqueo raquídeo fue más rápida en el grupo L que en el grupo C (162,43 ± 39,4 min vs. 219,73 ± 37,3 min [p = 0,000]). El tiempo en la sala de reanimación postanestesia fue menor en el grupo L que en el grupo C (109 ± 49,9 min vs. 148 ± 56,8 min [p = 0,036]). No hubo diferencia entre los grupos con relación a la incidencia de eventos adversos y tratamientos. Los grupos también fueron similares en lo que respecta a las complicaciones. No se observó en ningún grupo ni cefalea pospunción dural ni síntomas neurológicos transitorios. Conclusión: la adición de una ...

Clinical observation on analgesic effect of flurbiprofen for spastic pain after TUR-P / 局解手术学杂志

Objective To observe the analgesic effect and its complications of flurbiprofen axetil for spastic pain after transurethral re-section of prostate( TUR-P) . Methods 40 patients who were clinically diagnosed as benign prostatic hyperplasia and underwent TUR-P were randomly divided into the experimental group (n=20)and the control group(n=20). When the postsurgical spastic bladder pain happened, the patients in the experimental group received intravenous drip of flurbiprofen axetil 100 mg with saline 500 mL,and the patients in the con-trol group received intramuscular injection of pethidine hydrochloride 100 mg. If its effect is not good,100 mg bucinnazine hydrochloride were injected. Analgesia efficacy was assessed by visual analog scales( VAS) at 30 min,1 h,2 h,4 h,6 h and 8 h after medication. At the same time,the side-effects and complications were observed and recorded. Results There is no statistical difference between the experimental group and the control group at 30 min,1 h, and 2 h after medication(P>0. 05),but at 4 h,6 h and 8 h after medication,VAS score of the experimental group is obviously lower than that of the control group(P0. 05). Conclusion Intravenous drip of flurbiprofen axetil can be an ef-fective and safe way of curing postsurgical spastic bladder pain after TUR-P.

La vaporización fotoselectiva del adenoma prostático con el ktp-láser (kalium-titanyl-phosphat) de 80 watt y la RTU-P de baja presión hidráulica / The photoselective vaporization of prostate adenoma with the 80 watt ktp-laser (kalium-titanyl-phosphat) and the low hydraulic pressure tur-p

El objetivo de este trabajo prospectivo es determinar la eficacia del método KTP-láser de 80 watt para la vaporización y ablación de la HPB sintomática. También se analizan los resultados al combinar el KTP-láser con la RTU-P y su repercusión sobre la hemoglobina. Material y Método: 300 pacientes con HPB sintomática fueron tratados entre agosto del 2004 y noviembre del 2006 con el KTPláser o combinado con RTU-P. La resección adicional fue efectuada en pacientes con adenomas grandes o por lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS. Resultados: 300 pacientes fueron tratados en 2 grupos. El grupo 1 (n: 50) con sólo tratamiento láser y pequeños adenomas, la hemoglobina se redujo un 3,2 por ciento y nadie requirió una transfusión. El grupo 2 (n: 250) con tratamiento combinado de KTP-láser y RTU-P en adenomas grandes, la hemoglobina se redujo en promedio 15,2 por ciento después de la intervención; 2 pacientes (0,8 por ciento) necesitaron una transfusión. Conclusión: El estudio pone de manifiesto, las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma sobre todo en próstatas de gran tamaño.

The objective of this prospective study is to determine the effectiveness of the 80 watt KTP laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the TUR-P and their repercussion on the haemoglobin are analysed. Material and Method: 300 patients with symptomatic BPH were treated between august 2004and november 2006 with the KTP-Laser or combined with TUR-P. The additional Resection was carried out in those patients with great adenomas or to have accentuated middle lobule. The ablative effect was controlledat the end of the operation with TRUS (transrectal ultrasound). Results: 300 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas, the haemoglobin was reduced a 3.2 percent and nobody required a transfusion. Group 2 (n: 250) with combined treatment of KTP-laser and TURP in great adenomas, the haemoglobin was reduced in average 15,2 percent after the intervention; 2 patients (0,8 percent) needed a transfusion. Conclusion: Our study puts of open, the advantages to combine both surgical procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.

The Results of Benign Prostatic Hyperplasia Treatment by Transurethral Resection, Open Prostatectomy, and TUMT(Transurethral Microwave Thermotherapy) / 대한비뇨기과학회지

We noticed the treatment results of each of them after having treated the seventy-nine cases of benign prostatic hyperplasia with TUMT (N=32, Term ; 92.6-93.3), TUR-P (N=31, Term; 91.4-93.3), open prostatectomy (N=16, Term; 91.4-93.3). However, there was a difficulty to get to statistical reliability, for there was a little gap between the term of survey and the period of treatment of three groups. The results are following. In the TUMT, the maximal flow rate was improved from 8.2ml/s to 13.3ml/s and Madsen score dropped from 13.6 to 5.3, in the TUR-P they were 8.4ml/s to 16.5ml /s and 14.5 to 5.3 respectively, and in the open prostatectomy 6.8ml/s to 20.0ml/s and 15.8 to 5. 3 respectively. The degree of satisfaction of the patients themselves with each prescription was 46.9% in the TUMT. 67.7% in the TUR-P and 81.2% in the open prostatectomy. But 18.8% and l6.l% of the patients thought TUMT and TUR-P respectively ineffective. The conclusion is that open prostatectomy presented the better results than TUMT or TUR-P in the degree of satisfaction of patients and uroflowmetry during the survey period. And even though TUMT have presented lesser degree of satisfaction then TUR-P up to now, if the exact indications for the use of TUMT are found and the mechanical improvements undergo, then a number of benign prostatic hyperplasia cases seem to be treated in more safety and with lesser cost and time by TUMT instead of TUR-P.