Current updates on post-operative pain management

This article discusses the current updates in the post-operative pain management with regards to the pathophysiology of pain, adverse physiologic sequelae of pain, pharmacological considerations, and the use of oral, parenteral, peripheral nerve blocks and neuraxial analgesics in conjunction with the mutimodal approach in controlling post- surgical pain for better patient outcome.

Comparison of onset and duration of neuromuscular blockade following divided doses of vecuronium in Filipino subjects: "The priming principle refined"

The effects of three different intubating doses of vecuronium were investigated using the refined priming principle. Sixty patients were studied. Twenty patients were each allocated randomly into three groups I, II, and III and received 0.12, 0.15, and 0.20 mg/kg intubating dose of vecuronium respectively. The priming dose of 0.01 mg/kg and the priming interval of 4 minutes were the same for all groups. The degree of neuromuscular block were determined by the train-of-four (TOF) ratios with the use of the TOF-GUARD nerve stimulator. Onset time (from injection of the intubating dose to 95% and 100% suppression of the TOF), clinical duration (return of the first twitch from maximum block to 25% of the TOF), and intubation conditions were determined. The onset time to 95% and 100% of the TOF were significantly shorter as the intubating dose of vecuronium were increased (at 0.12 mg/kg, onset was 151 +/- 15s; at 0.15 mg/kg, onset was 97 +/- 16s; and at 0.20 mg/kg, onset was 69 +/- 10s). The clinical duration was significantly increased between group I (60 +/- 11 min) and both groups II (77 +/- 15 mm) and III (74 +/- 17 mm), but not significant between groups II and III. The changes in the heart rate and mean arterial pressure in all groups were not significant. In conclusion, a priming dose of 0.01 mg/kg followed by a larger intubating dose (0.20 mg/kg) four minutes later provides an excellent intubation condition within 69 +/- 10s with no clinically significant hemodynamic changes. (

Combined spinal-epidural vs. epidural anesthesia in abdominal surgery

BACKGROUND: Combined spinal-epidural anesthesia is becoming popular especially in obstetrics and orthopedics, however few studies have been done involving abdominal operations METHODOLOGY: A randomized, blind study was conducted to compare the clinical outcome of combined spinal-epidural anesthesia (CSEA) with epidural anesthesia (EA) in abdominal surgery. CSEA was established using tetracaine 0.5 percent for the spinal component and bupivacaine 0.5 percent for the epidural component, whereas EA was established using bupivacaine 0.5 percent and fentanyl. Sixty patients were enrolled (Group CSEA, n=30; Group EA, n=30) RESULTS: The ease of doing the procedures were similar in both groups. Of the two techniques, CSEA was associated with earlier onset times (p0.05), more intense motor block (100 percent in the CSEA group achieved compete motor block compared to 10 percent in the EA group). Ephedrine use was similar in both groups. Pain scores were similar in both groups. Overall patient satisfactions were higher in the CSEA groups. The incidence of shivering was higher in the EA group (33 percent) compared to CSEA group (17 percent). Pruritus was present only in the EA group (10 percent). Nauses, vomiting, and headache were absent in both groups CONCLUSIONS: CSEA is a useful and safe technique that confers advantages over the EA technique for major abdominal surgery. CSEA has low failure rates, rapidly produces a reliable spinal blockade, provides good operating conditions, and offers high level of patient satisfaction.