Subject(s)
Analgesia/standards , Analgesics/therapeutic use , Critical Care/standards , Hypnotics and Sedatives/therapeutic use , Analgesics/administration & dosage , Analgesics/pharmacokinetics , Child , Communication , Conscious Sedation , Drug Therapy , Drug Tolerance , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/pharmacokinetics , Pain Measurement , Pharmacokinetics , Sleep , Substance Withdrawal Syndrome/prevention & control , Wounds and Injuries/therapySubject(s)
Conscious Sedation , Intensive Care Units , Critical Care , Humans , Monitoring, PhysiologicABSTRACT
AIM: In this study the authors compared the clinical profile of 2 local anesthetic drugs in the sciatic nerve block used during hallux valgus correction, a surgical procedure known to be post-operatively extremely painful. Since hallux valgus correction is painful post-operatively, many attempts have been tried to ensure a long-lasting analgesia. Block of the sciatic nerve appears to be the right choice balancing ease to performance, satisfaction of the patient and duration of action. METHODS: The authors investigated the use of 20 ml of 0.5% bupivacaine or 0.75% ropivacaine regarding the speed of onset, quality and length of duration of sciatic nerve block performed with a lateral popliteal approach. Sixty ASA I-III patients (aged 19-73 years) were enrolled in this trial. Written informed consent was asked and obtained. A 20 G 50 mm Teflon coated Crawford needle, delivering 0.5 mA at 2 Hz, was used to locate and block the sciatic nerve in the popliteal fossa with a lateral approach. RESULTS: Patients in the ropivacaine group required about 13 minutes to achieve a complete block and about 16 minutes were needed in the bupivacaine group for the anesthesia to be complete. The length of analgesia was 16 h for the ropivacaine group and 13 h for the bupivacaine group. This kind of approach to block the sciatic nerve appeared to the authors to be very easy to perform, with the patient lying in a natural position. Surgical anesthesia required less than 30 min in both groups to be ready, while the ropivacaine group had a longer length of analgesia compared to the bupivacaine group. CONCLUSIONS: Patient satisfaction was high in both groups.
Subject(s)
Amides , Anesthetics, Local , Bupivacaine , Hallux Valgus/surgery , Nerve Block/methods , Sciatic Nerve , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Nerve Block/adverse effects , RopivacaineABSTRACT
BACKGROUND: The recent introduction of BIS has improved the concept of utilizing it as a method for the assessment of the sedation level, thus opening new frontiers in critically ill patients care. Its validity in measuring the hypnotic drug effects has been repeatedly proved, but it has rarely been used in ICU. The aim of this paper is to evaluate the correlation between BIS and Ramsay score and its fluctuations with the sedative dosage variations, as a possible utilization in ICU. METHODS: In this study, 20 patients with severe lung disease requiring ventilator support, were recruited. All patients were sedated with propofol and/or midazolam to maintain a Ramsay score of 4. Continuous infusion techniques were commonly used. At time 0 and every half an hour, the patients were evaluated by 2 investigators, using the Ramsay score and the BIS simultaneously. The BIS was calculated by a 1-min recording every time that the sedation score was recorded, for a total of 960 observations. In addition BIS was continuously recorded to establish a baseline value, when the patient was not stimulated. Ventilator settings, medications and vital signs were also recorded. RESULTS: With the increase of the Ramsay score there was a progressive decrease in the BIS score (Ramsay score=2, BIS=88 +/- 15.1; Ramsay score=6, BIS=52.2 +/- 10.7); between BIS and Propofol dosages and between Ramsay score and systolic pressure. CONCLUSIONS: The data obtained show a good correlation between Ramsay score and BIS.
