Does topical ropivacaine reduce the post-tonsillectomy morbidity in pediatric patients?

OBJECTIVES: To determine whether post-operative administration of topical ropivacaine hydrochloride decreases morbidity following adenotonsillectomy. STUDY DESIGN: Prospective, randomized, double-blind clinical trial. SETTING: University referral center; ENT Department. PARTICIPANTS: Fourty one children, aged 4-16 years, undergoing tonsillectomy. METHODS: Patients received 1.0% ropivacaine hydrochloride soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Mc Grath's face scale was used to compare the two groups in respect of pain control. Chi-square and two-tailed unpaired Student's t-tests or Mann-Whitney-U-tests were used to compare the two independent groups. As 10 we made 11 comparison between groups, for Bonferroni correction, p<0.005 was accepted as statistically significant. RESULTS: Only first hour there was no significant pain-relieving effect seen in the ropivacaine group (p>0.05). The other hours and days there were statistically significance between the two groups (p<0.001). Also, the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups. There were no complications associated with ropivacaine hydrochloride. No patients in this study suffered systemic side effects related to the use of this medication. CONCLUSION: Locally 1.0% ropivacaine administration significantly relieves the pain of pediatric tonsillectomy and, it is a safe and effective method. High concentrations of ropivaciane may produce clinically significant pain relief. It is more effective to reduce of post-operative analgesic requirement after first hour.

The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study.

The aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction with care to date and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute: heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P > 0.05), and high satisfaction levels (90.1+/-3.0 for dexmedetomidine versus 84.9+/-4.5 for midazolam; P > 0.05). Retching and endoscopist satisfaction were significantly different in patients receiving dexmedetomidine versus those receiving midazolam (88.8+/-6.5 versus 73.5+/-16.4, P < 0.05; and 20.6+/-4.4 versus 45.2+/-6.0; P < 0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P < 0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy.

Intrathecal sufentanil (1.5 microg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy.

PURPOSE: We compared the effects of different doses of intrathecal sufentanil when administered together with hyperbaric bupivacaine for elective caesarean section. METHODS: This was a prospective, randomized, double-blind, controlled trial involving 100 pregnant women, American Society of Anesthesiologists (ASA) I-II, who were scheduled for elective caesarean section under spinal anesthesia. The patients were assigned to four groups according to the dose of sufentanil used: no sufentanil (group I; placebo) or 1.5, 2.5, or 5.0 microg sufentanil (groups 2-4, respectively). In every group, the local anesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg), and the total volume of the solution was 3.5 ml. The duration of complete analgesia, maternal side effects, and maternal/fetal outcomes were recorded. The duration of complete analgesia was defined as the time from intrathecal injection to a vernal analogue score (VAS) of more than 0. RESULTS: No patient experienced intraoperative pain. The duration of complete analgesia was prolonged in all groups receiving opioids. The duration of the analgesia and the 0- to 6-h intravenous analgesic requirements were similar in the sufentanil groups. Moreover, the sufentanil groups had longer durations of complete analgesia than the placebo group. Pruritus was more frequent in the 2.5- and 5-microg sufentanil groups than in the 1.5-microg sufentanil and placebo groups. There were no differences among the groups in umbilical cord blood gases on in neonatal Apgar scores. CONCLUSION: The addition of sufentanil 1.5 and 2.5 microg to hyperbaric bupivacaine provided adequate anesthesia for caesarean delivery and good postoperative analgesia. In addition, the incidence of pruritus was significantly lower in the 1.5-microg sufentanil group when compared with that in the 2.5- and 5-microg groups.

Does tramadol wound infiltration offer an advantage over bupivacaine for postoperative analgesia in children following herniotomy?

BACKGROUND: It has been demonstrated that tramadol is an effective analgesic. We aimed to compare postoperative analgesic effects of wound infiltration with tramadol (T) or bupivacaine (B) and intramuscular tramadol (I) after herniotomy in children. METHODS: In this study, 75 children were randomly assigned to group T, group B and group I. Wound infiltration was performed to the patients in group T (2 mg.kg-1 tramadol in 0.2 ml.kg-1 saline) and group B (0.2 ml.kg-1 0.25% bupivacaine) into the surgical incision. Twenty minutes before the end of the surgery 2 mg.kg-1 tramadol was injected i.m. in group I. Faces pain scale was used for assessing pain severity. Patients with pain score>2 were treated with paracetamol. The frequency of side effects and analgesic use were recorded. Patients were discharged on the next day. RESULTS: No side effects were recorded in any group. The pain scores of the patients at the first, fourth and eighth hours were significantly higher in group B and group I than group T (P<0.05). The pain scores of the patients at the first hour were significantly higher in group I compared with group B (P<0.05). Average time to first analgesic requirement was significantly longer in group T (6.72+/-4.09 h after herniotomy than both group I (4.49+/-3.9 h) and group B (6.04+/-3.7 h) (P<0.05). CONCLUSIONS: Wound infiltration with tramadol may be a good choice for postoperative analgesia in children having inguinal herniotomy.

Effects of sevoflurane and TIVA with propofol on middle ear pressure.

OBJECTIVE: To evaluate the effects of sevoflurane and TIVA with propofol on middle ear pressure and to show the importance of anesthesia without using any inhalational agents during middle ear surgery. STUDY DESIGN: A prospective, randomized controlled clinical study. METHODS: In this study, 25 male children that were scheduled for circumcision were randomised into two groups. Group I (n=13) received TIVA with propofol and group II (n=12) received sevoflurane. Baseline tympanometry reading was performed on each ear just before anesthesia. The next tympanometry reading was taken 10min after applying the laryngeal mask. Data were analysed by Mann-Whitney U (between groups) and Wilcoxon tests (within groups). RESULTS: Mean MEP values in 26 ears of 13 boys in group I did not show any significant difference before and after the anesthesia with propofol (p>0.05). In group II mean MEP values in 24 ears of 12 boys showed a significant increase after the anesthesia with sevoflurane (p<0.001). No significant difference was found between the MEP values of the two groups before the anesthesia (p>0.05), and MEP values measured during the anesthesia were significantly higher in group II (p=0.007). CONCLUSION: Sevoflurane may increase the middle ear pressure and TIVA with propofol may be used in middle ear operations more safely than sevoflurane.