Efficacy of different doses of sugammadex after continuous infusion of rocuronium.

AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuronium-induced neuromuscular blockade (NMB). METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification I-II, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg (group A) or 4 mg/kg (group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables (arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit. RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively. The estimated difference in recovery time between groups was 24 s (95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8 (group A: 101 s; group B: 82.5 s) and 0.7 (group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-Of-Four is reached.

[Continuous paravertebral block as an analgesic method in thoracotomy]. / Eficacia del bloqueo paravertebral continuo como método analgésico en la toracotomía.

INTRODUCTION: Open thoracotomy is one of the surgical procedures that is still very painful in the postoperative period, which, in this type of surgery can have on respiratory function and subsequent recovery of the patient. PATIENTS AND METHOD: The aim of the study is to assess continuous paravertebral thoracic block as an analgesic technique in thoracotomy. A total of 139 patients undergoing pulmonary resection surgery by posterolateral thoracotomy received postoperative analgesia using a 1.5% lidocaine infusion (7-10 ml/h) through a thoracic paravertebral catheter for at least 48 h. Pain intensity measured on the visual analogue scale (VAS) both at rest (passive VAS) and during stimulated cough (active VAS) was recorded at time of discharge from the Recovery Unit, and on the second, third and fourth day post-surgery. Postoperative complications and the need for analgesic rescue were studied. RESULTS: On discharge from recovery, 98.6% of the patients had mild pain (passive VAS <3), 1.4% had moderate pain (passive VAS 4-6) and none with severe pain (EVA >6); on the 2nd day post-surgery, 97.9% had mild pain, and 1.2% moderate pain; on the third day 98.6% had mild pain and 0.7% moderate pain; and on the 4th day 100% had mild pain. There were no complications arising from the analgesic technique. CONCLUSIONS: Continuous thoracic paravertebral analgesia is effective and safe in controlling post-thoracotomy pain.

Eficacia del bloqueo paravertebral continuo como método analgésico en la toracotomía / Continuous paravertebral block as an analgesic method in thoracotomy

Introducción: La toracotomía abierta es uno de los procedimientos quirúrgicos con postoperatorio más doloroso, hecho que en este tipo de cirugía puede repercutir sobre la función respiratoria y posterior recuperación del paciente. Paciente y método: El propósito del estudio es evaluar el bloqueo paravertebral contínuo torácico como técnica analgésica en la toracotomía. Ciento treinta y nueve pacientes sometidos a cirugía de resección pulmonar mediante toracotomía posterolateral recibieron analgesia postoperatopria mediante infusión de lidocaína al 1,5% (7–10ml/h) a través de un catéter paravertebral torácico y durante un mínimo de 48h. La intensidad del dolor mediante la escala analógica visual (EVA) tanto en reposo (EVA pasivo) como durante la tos incentivada (EVA activo), fue registrada al alta de la unidad de reanimación, al segundo, tercer y cuarto día postoperatorio. Se estudiaron las complicaciones postoperatorias y la necesidad de analgesia de rescate. Resultados: Al alta de reanimación un 98,6% de los pacientes presentaron un dolor leve (EVA pasivo <3 un 1 4 dolor moderado eva pasivo ndash 6 y 0 severo 6); en el 2.° día postoperatorio un 97,9% tuvieron un dolor leve, y un 1,2% dolor moderado; en el 3.er día un 98,6% un dolor leve y un 0,7% dolor moderado; y al 4° día un 100% presentaron dolor leve. No se encontraron complicaciones derivadas de la técnica analgésica. Conclusiones: La analgesia paravertebral torácica contínua es efectiva y segura en el control del dolor postoracotomía (AU)

Introduction: Open thoracotomy is one of the surgical procedures that is still very painful in the postoperative period, which, in this type of surgery can have on respiratory function and subsequent recovery of the patient. Patients and method: The aim of the study is to assess continuous paravertebral thoracic block as an analgesic technique in thoracotomy. A total of 139 patients undergoing pulmonary resection surgery by posterolateral thoracotomy received postoperative analgesia using a 1.5% lidocaine infusion (7–10ml/h) through a thoracic paravertebral catheter for at least 48h. Pain intensity measured on the visual analogue scale (VAS) both at rest (passive VAS) and during stimulated cough (active VAS) was recorded at time of discharge from the Recovery Unit, and on the second, third and fourth day post-surgery. Postoperative complications and the need for analgesic rescue were studied. Results: On discharge from recovery, 98.6% of the patients had mild pain (passive VAS <3 1 4 had moderate pain passive vas ndash 6 and none with severe eva 6); on the 2nd day post-surgery, 97.9% had mild pain, and 1.2% moderate pain; on the third day 98.6% had mild pain and 0.7% moderate pain; and on the 4th day 100% had mild pain. There were no complications arising from the analgesic technique. Conclusions: Continuous thoracic paravertebral analgesia is effective and safe in controlling post-thoracotomy pain (AU)