ABSTRACT
The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p < 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p < 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score > 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p < 0.05).
Subject(s)
Acetaminophen/administration & dosage , Analgesia/methods , Fracture Fixation/adverse effects , Hip Fractures/surgery , Morphine/administration & dosage , Pain Management/methods , Pain, Postoperative , Aged , Analgesics/administration & dosage , Analgesics/classification , Cohort Studies , Drug Administration Routes , Drug Administration Schedule , Female , Fracture Fixation/methods , Humans , Male , Nerve Block/methods , Pain Measurement/methods , Pain, Postoperative/diagnosis , Pain, Postoperative/therapy , Retrospective Studies , TherapeuticsABSTRACT
PURPOSE: A hemodynamic event such as hypertension after interscalene block (ISB) is a complication that is often overlooked. The irregular spread of local anesthetic would cause a blockade of carotid sinus baroreceptors leading to the adverse event. The purpose of the present study is to compare ultrasound and neurostimulation technique in preventing hypertension after ISB. METHODS: Thirty patients without hypertension history who underwent arthroscopic shoulder surgery for a rotator cuff tear were enrolled. After preoperative administration of the State Trait Anxiety Inventory questionnaire, patients were allocated to receive ultrasound-guided ISB with 20 ml levobupivacaine-HCl 0.5 % (group US) and 40 ml levobupivacaine-HCl 0.5 % with neurostimulation (group NS). The need for antihypertensive drug was recorded. Block onset sensory and motor times were assessed. Systolic and diastolic blood pressures, and heart rate and pulse oximetry (SpO2), were evaluated before the block as well as 2, 5, 10, 15, 20, and 30 min after. RESULTS: No differences in patient characteristics and anxiety were found in the two groups. Block onset times were similar. At 15 min after block placement, group NS showed significantly higher systolic and diastolic blood pressures compared to group US. No differences in heart rate and SpO2 were found between the two groups. Three patients of group NS required urapidil administration because of hypertension. CONCLUSIONS: Ultrasound-guided ISB permits the use of a low volume of local anesthetic and seems to reduce the incidence of hypertension.
Subject(s)
Anesthetics, Local/therapeutic use , Bupivacaine/analogs & derivatives , Hemodynamics , Hypertension/etiology , Nerve Block/adverse effects , Nerve Block/methods , Adult , Aged , Aged, 80 and over , Anesthetics, Local/administration & dosage , Arthroscopy/methods , Brachial Plexus/diagnostic imaging , Bupivacaine/administration & dosage , Bupivacaine/therapeutic use , Female , Humans , Levobupivacaine , Male , Middle Aged , Shoulder/surgery , Ultrasonography/adverse effects , Ultrasonography/methodsABSTRACT
BACKGROUND AND OBJECTIVES: Stimulation of the radial nerve at the axilla may cause either a proximal movement (forearm extension) or distal movements (supination, wrist or finger extension). In the most recent studies on axillary block, only a distal twitch was accepted as valid. However, this approach was based only on clinical experience. The aim of this study was to verify if a proximal motor response can be considered a satisfactory endpoint. METHODS: This was a prospective, randomized, double-blinded study. One hundred fifty patients received a triple-injection axillary brachial plexus block in which the radial nerve was located by a proximal (group PROX) or a distal motor response (group DIST). Patients were assessed for sensory and motor block of the branches of the radial nerve by a blinded investigator at 5-minute intervals over 30 minutes. RESULTS: An 81% success rate for anesthetizing the sensory distal branches of the radial nerve was seen in group PROX; a significantly higher success rate was recorded in group DIST (95%). The onset time of sensory block for the distal branches of the radial nerve was significantly shorter in group DIST (9.9 +/- 6 v 15.4 +/- 7 minutes). The time to perform the block was slightly shorter and the localization of the nerve simpler in group PROX. The overall block success rate was not significantly different in the 2 groups. CONCLUSIONS: Local anesthetic injection at the proximal radial twitch significantly reduces the efficacy and prolongs the onset time of the radial nerve block. Searching for distal response is significantly more difficult and time consuming than searching for proximal response. However, it does not significantly increase patient discomfort or adverse effects.
