Operating unit time use is associated with anaesthesia type in below-knee surgery in adults.

BACKGROUND: Peripheral nerve blocks could reduce the operating unit and theatre time spent on high-risk patients who are particularly vulnerable to complications of general anaesthesia or have medications that prevent application of central neuraxial blocks. METHODS: Medical record data of 617 and 254 elderly adults undergoing below-knee surgery in Jorvi and Meilahti hospitals (Helsinki University Hospital) between January 2010 and December 2012 were used to investigate the influence of anaesthetic technique on operating theatre times and on operating unit times using flexible parametric survival models. We report operating theatre and unit exit ratios (i.e. hazard ratios but using ratios of exit rates) for different types of anaesthesia. RESULTS: Adjusted analyses: In Jorvi Hospital, anaesthesia type was associated with large initial differentials in operating theatre times. The theatre exit ratios remained lower for general anaesthesia and central neuraxial blocks compared to peripheral nerve blocks until 30 min. In Meilahti Hospital, anaesthesia type did not influence theatre time, but was the best predictor of operating unit times. Compared to peripheral nerve blocks, the exit ratio remained lower for general anaesthesia until five operating unit hours in both hospitals and for central neuraxial blocks until 1 h in Meilahti Hospital and until 3 h in Jorvi Hospital. Holding area was used more in Jorvi Hospital compared to Meilahti Hospital. CONCLUSION: Peripheral nerve block anaesthesia reduces time spent in the operating unit and can reduce time spent in the operating theatre if induced in holding area outside of theatre.

Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgery.

BACKGROUND: Dexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus. METHODS: Sixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone doses. In addition, adverse effects were documented. RESULTS: Twenty-five patients in both groups completed the study. The total median (range) oxycodone consumption during the study period was 45 (0-165) mg in the dexamethasone group and 78 (15-175) mg in the placebo group (P=0.049). The major differences in oxycodone consumption were seen on PODs 0-1. In the dexamethasone group, patients reported significantly lower pain scores on PODs 0-1, and significantly less nausea on POD 1. On PODs 2-3 no differences were seen. However, at 2 weeks post-operatively, patient satisfaction to drug therapy did not differ - in both groups 81% would have chosen the same medication again. CONCLUSION: Oral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus.

Effects of alfentanil and fentanyl on common bile duct pressure.

The effects of alfentanil (7.5 or 15 micrograms/kg) and fentanyl (1.5 micrograms/kg) on common bile duct pressure were examined by using an indwelling postoperative T-tube in 36 conscious, unpremedicated patients. All opiate doses significantly (P less than 0.001) increased the pressure. There was no significant difference among the groups in the peak pressures nor in the times to peak pressures. Fentanyl had a significantly longer duration of effect on pressure.