Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery.

PURPOSE: This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. METHODS: This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. RESULTS: A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. CONCLUSION: The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

[Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates]. / Níveis plasmáticos de interleucina-10 e óxido nítrico em resposta a duas taxas de fluxo em anestesia com desflurano.

OBJECTIVE: This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. MATERIALS AND METHODS: Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. INTERVENTIONS: Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF) and low flow (Group LF). MEASUREMENTS: Blood samples were drawn at the beginning (t0) and end (t1) of the operation and after 24h (t2). Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. RESULTS: There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t1 and t2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t2. No correlation was found between the IL-10 and nitric oxide levels. CONCLUSION: Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations; however, at 24h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels.

Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates.

OBJECTIVE: This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. MATERIALS AND METHODS: Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. INTERVENTIONS: Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF) and low flow (Group LF). MEASUREMENTS: Blood samples were drawn at the beginning (t0) and end (t1) of the operation and after 24h (t2). Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. RESULTS: There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t1 and t2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t2. No correlation was found between the IL-10 and nitric oxide levels. CONCLUSION: Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations; however, at 24h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels.

Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates / Níveis plasmáticos de interleucina-10 e óxido nítrico em resposta a duas taxas de fluxo em anestesia com desflurano / Niveles plasmáticos de interleucina-10 y óxido nítrico en respuesta a 2 tasas de flujo en anestesia con desflurano

OBJECTIVE: This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. MATERIALS AND METHODS: Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. INTERVENTIONS: Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF) and low flow (Group LF). MEASUREMENTS: Blood samples were drawn at the beginning (t 0) and end (t 1) of the operation and after 24 h (t 2). Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. RESULTS: There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t 1 and t 2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t 1 and t 2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t 2. No correlation was found between the IL-10 and nitric oxide levels. CONCLUSION: Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t 1 and t 2 compared with preoperative concentrations; however, at 24 h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels. .

OBJETIVO: este estudo investigou os níveis plasmáticos de interleucina-10 e óxido nítrico após cirurgia para determinar se há correlação entre essas duas variáveis e se diferentes taxas de fluxo de anestesia com desflurano influenciam as concentrações de interleucina-10 e óxido nítrico na circulação. MATERIAIS E MÉTODOS: quarenta pacientes, entre 18 e 70 anos de idade, estado físico ASA I-II, programados para tireoidectomia foram incluídos no estudo. INTERVENÇÕES: os pacientes foram divididos em dois grupos para receber dois fluxos diferentes de anestesia com desflurano: fluxo alto (Grupo FA) e fluxo baixo (Grupo FB). MENSURAÇÕES: amostras de sangue foram colhidas no início (t 0 ) e final (t 1 ) da cirurgia e após 24 h (t 2 ). Os níveis plasmáticos de interleucina-10 e óxido nítrico foram medidos usando um ensaio imunossorvente ligado à enzima um estojo de reagentes de Griess, respectivamente. Os parâmetros hemodinâmicos e respiratórios foram avaliados. RESULTADOS: não houve diferença estatisticamente significante entre os dois grupos em relação aos níveis de interleucina-10 níveis nos tempos de medição. Os níveis de interleucina-10 aumentaram igualmente em ambos os grupos nos tempos t 1 e t 2 em comparação com as concentrações no pré-operatório. Em ambos os grupos, as concentrações circulantes de óxido nítrico estavam significativamente reduzidas nos tempos t 1 e t 2 em comparação com as concentrações no pré-operatório. No entanto, o valor de óxido nítrico foi menor no Grupo FA que no Grupo FB no t 2 . Não houve correlação entre os níveis de IL-10 e óxido nítrico. CONCLUSÃO: o ...

OBJETIVO: este estudio investigó los niveles plasmáticos de interleucina-10 y óxido nítrico después de la cirugía para determinar si hay alguna correlación entre esas 2 variables y si diferentes tasas de flujo de anestesia con desflurano influyen en las concentraciones de interleucina-10 y óxido nítrico en la circulación. MATERIALES Y MÉTODOS: cuarenta pacientes, entre 18 y 70 años de edad, estado físico ASA I-II, programados para tiroidectomía se incluyeron en el estudio. INTERVENCIONES: los pacientes se dividieron en 2 grupos para recibir 2 flujos diferentes de anestesia con desflurano: flujo alto (grupo FA) y flujo bajo (grupo FB). MEDICIONES: se extrajeron muestras de sangre al inicio (t 0 ) y al final (t 1 ) de la cirugía y después de 24 h (t 2 ). Los niveles plasmáticos de interleucina-10 y óxido nítrico fueron medidos usando un ensayo de inmunoabsorción conectando un kit de reactivos de Griess, respectivamente. Se evaluaron los parámetros hemodinámicos y respiratorios. RESULTADOS: no hubo diferencia estadísticamente significativa entre los 2 grupos con relación a los niveles de interleucina-10 en los tiempos de medición. Los niveles de interleucina-10 aumentaron igualmente en ambos grupos en los tiempos t 1 y t 2 en comparación con las concentraciones en el preoperatorio. En ambos grupos, las concentraciones circulantes de óxido nítrico estaban significativamente reducidas en los tiempos t 1 y t 2 en comparación con las concentraciones en el preoperatorio. Sin embargo, el valor de óxido nítrico fue menor en el grupo FA que en el grupo FB en el t 2 . No hubo correlación entre los niveles de interleucina-10 y óxido nítrico. CONCLUSIÓN: el uso clínico de 2 flujos diferentes en anestesia con desflurano puede aumentar los ...

The effect of intraarticular levobupivacaine and bupivacaine injection on the postoperative pain management in total knee artroplastic surgery.

OBJECTIVE: Total knee arthroplasty (TKA) is associated with considerable postoperative pain. We compared the effects of intraoperative intraarticular levobupivacaine and bupivacaine on postoperative analgesia and analgesic consumption after total knee arthroplasty. METHODS: Sixty ASA (American Society of Anesthesiologists) physical status II-III, 18-75 years old patients scheduled for unilateral TKA were included in this study. For the operative procedure combined spinal epidural anesthesia was given by injecting 15mg levobupivacaine in subarachnoid space at L3-4/L4- 5 in sitting position for all patients. In Group L 20ml levobupivacaine(0.5%), in Group B 20ml bupivacaine (0.5%) was injected intraarticularly 10 minutes before opening of the tourniquet at the end of the surgery. For all patients postoperative analgesia was provided with PCEA (levobupivacaine+fentanyl) and oral 1gr paracetamol four times a day. Patients' intraoperative-postoperative hemodynamical data, postoperative sensorial-motor block characteristics, side effects, PCEA demand ratios and bolus volumes, total analgesic consumption, VAS values, first mobilization time, hospitalization time were recorded. Statistical analysis was performed with SPSS version 13.00 software. RESULTS: There was no intergroup difference in demographic data, hemodynamical data, PCEA demand ratios, total analgesic consumption, first mobilization time, hospitalization time and VAS values at 0,2,72 hour. Postoperative lower VAS values were determined at 4,8,12,24 hours in Group B and at 48(th) hour in Group L(p<0.05). CONCLUSIONS: Intraarticular local anesthetic administration in addition to PCEA for post operative pain relief provides good analgesia after TKA surgery.

Retrospective Evaluation of Anaesthesia Techniques for Hip Replacement Operations.

OBJECTIVE: In this retrospective study, we evaluated the demographic characteristics of patients that underwent hip replacement surgery in our orthopedic clinic. Associated diseases, preoperative laboratory findings, intraoperative findings, and the effect of admission or refusal to the intensive care unit on postoperative mortality and morbidity were recorded. Furthermore, we tried to identify surgical and anaesthetic methods applied, intraoperative hemodynamic changes, length of stay in the post-anaesthesia care unit, and postoperative complications. METHODS: Demographic characteristics, co-morbidities, preoperative laboratory findings, intraoperative findings, and admission or refusal to the intensive care unit of patients who underwent hip replacement surgery between January 2008-December 2010 were enrolled. RESULTS: Out of 500 patients, 33.4% (n=164) were operated under general anaesthesia, 34% (n=170) under combined spinal-epidural anaesthesia, 22.2% (n=111) under spinal anaesthesia, 6.4% (n=32) under combined lomber plexus block and sciatic nerve block, and 4% (n=20) under epidural anaesthesia. Mean hospital stay was 7 days in the general anaesthesia group and 5 days in the regional anaesthesia group. CONCLUSION: American Society of Anesthesiologists (ASA) scores and incidence of co-morbidities were higher in the partial hip replacement group. Admission to the intensive care unit was lower in the total hip replacement group. Hospital stay was shorter in the partial hip replacement group. Mortality rates on the 7(th) and 30(th) days were higher in the partial hip replacement group.

Patient-controlled sedation in orthopedic surgery under regional anesthesia: a new approach in procedural sedation.

BACKGROUND AND OBJECTIVES: Regional anesthesia is a commonly used technique in orthopedic procedures. Sedation should reduce the patient's anxiety and fear while increasing regional anesthesia quality. This study evaluated the hemodynamic changes, level of sedation, both patients' and surgeons' levels of satisfaction and potential side effects in patient-controlled sedation using propofol. METHODS: This randomized clinical trial studied sixty ASA physical class I-III patients scheduled for total knee replacement surgery under combined spinal-epidural anesthesia. Patients in Group P (n = 30) received propofol via a patient-controlled analgesia device with the following settings: intravenous propofol bolus dose 400 µg.kg(-1), 5-minute lockout interval and no basal infusion. In Group S, we infused saline 150 using the same settings. To determine the level of sedation, we used BIS and Observer's Assessment of Alertness/ Sedation Scale. For all patients, we recorded the number of requests. As the fi nal evaluation, we scored surgeons' and patients' satisfaction on 4-point scales. RESULTS: Both BIS values and OAA/S scores were lower in Group P than in Group S. Patients' satisfaction was higher in Group P, although there was no significant difference with respect to surgeons' satisfaction between the groups. The number of requests for sedation was significantly higher in Group S. However, most requests were considered unsuccessful. CONCLUSION: This study suggests that patient-controlled sedation with propofol can be used efficiently in orthopedic procedures.

Sedação controlada pelo paciente em cirurgia ortopédica sob anestesia regional: uma nova abordagem em sedação / Patient-controlled sedation in orthopedic surgery under regional anesthesia: a new approach in procedural sedation / Analgesia controlada por el paciente en cirugía ortopédica bajo anestesia regional: un nuevo abordaje en sedación

JUSTIFICATIVA E OBJETIVOS: Anestesia regional é uma técnica de uso comum em procedimentos ortopédicos. A sedação deve reduzir a ansiedade e o medo do paciente e aumentar a qualidade da anestesia regional. Este estudo avaliou as alterações hemodinâmicas, o nível de sedação e de satisfação tanto dos pacientes quanto dos cirurgiões e os potencias efeitos colaterais da sedação controlada pelo paciente com o uso de propofol. MÉTODOS: Selecionamos 60 pacientes, estado físico Asa I-III e agendados para artroplastia total do joelho sob anestesia combinada raqui-peridural. Os pacientes do Grupo P (n = 30) receberam propofol por meio de um dispositivo de analgesia controlada pelo paciente com as seguintes configurações: dose de propofol em bolus de 400 µg.kg-1 por via intravenosa (IV), com intervalo de bloqueio de cinco minutos e sem infusão basal. Os pacientes do Grupo S receberam infusão de solução salina (150 mL), com as mesmas configurações. Para determinar o nível de sedação, o índice bispectral (BIS) e a Escala de Avaliação de Alerta e Sedação dos Observadores (OAA/S) foram usados. O número de solicitações foi registrado para todos os pacientes. Como avaliação final, a satisfação dos cirurgiões e dos pacientes foi registrada em escala de 4 pontos. RESULTADOS: Os valores de BIS e da OAA/S foram menores no Grupo P que no Grupo S. A satisfação dos pacientes foi maior no Grupo P, embora não tenha havido diferença significativa em relação à satisfação dos cirurgiões entre os grupos. O número de solitações de sedação foi significativamente maior no Grupo S. Contudo, a maioria das solicitações não foi considerada bem-sucedida. CONCLUSÃO: Este estudo sugere que a analgesia controlada pelo paciente com o uso de propofol pode ser usada com resultados eficazes em procedimentos ortopédicos.

BACKGROUND AND OBJECTIVES: Regional anesthesia is a commonly used technique in orthopedic procedures. Sedation should reduce the patient's anxiety and fear while increasing regional anesthesia quality. This study evaluated the hemodynamic changes, level of sedation, both patients' and surgeons' levels of satisfaction and potential side effects in patient-controlled sedation using propofol. METHODS: This randomized clinical trial studied sixty ASA physical class I-III patients scheduled for total knee replacement surgery under combined spinal-epidural anesthesia. Patients in Group P (n = 30) received propofol via a patient-controlled analgesia device with the following settings: intravenous propofol bolus dose 400 µg.kg_1, 5-minute lockout interval and no basal infusion. In Group S, we infused saline 150 using the same settings. To determine the level of sedation, we used BIS and Observer's Assessment of Alertness/ Sedation Scale. For all patients, we recorded the number of requests. As the final evaluation, we scored surgeons' and patients' satisfaction on 4-point scales. RESULTS: Both BIS values and OAA/S scores were lower in Group P than in Group S. Patients' satisfaction was higher in Group P, although there was no significant difference with respect to surgeons' satisfaction between the groups. The number of requests for sedation was significantly higher in Group S. However, most requests were considered unsuccessful. CONCLUSION: This study suggests that patient-controlled sedation with propofol can be used efficiently in orthopedic procedures.

JUSTIFICATIVA Y OBJETIVOS: La anestesia regional es una técnica de uso común en los procedimientos ortopédicos. La sedación debe reducir la ansiedad y el miedo del paciente y aumentar la calidad de la anestesia regional. Este estudio evaluó las alteraciones hemodinámicas, el nivel de sedación, los niveles de satisfacción tanto de los pacientes como de los cirujanos y los potencias efectos colaterales de la sedación controlada por el paciente con el uso de propofol. MÉTODOS: Seleccionamos 60 pacientes, estado físico Asa I-III programados para la artroplastia total de la rodilla bajo anestesia combinada raquiepidural. Los pacientes del Grupo P (n = 30) recibieron propofol por medio de un dispositivo de analgesia controlada por el paciente con las siguientes configuraciones: dosis de propofol en bolo de 400 µg.kg-1 vía intravenosa (IV), con un intervalo de bloqueo de cinco minutos y sin infusión basal. Los pacientes del Grupo S recibieron infusión de solución salina (150 mL), con las mismas configuraciones. Para determinar el nivel de sedación, usamos el índice bispectral (BIS) y la Escala de Evaluación del Índice de Alerta y Sedación del Observador (EAIASO). El número de solicitaciones fue registrado para todos los pacientes. Como evaluación final, la satisfacción de los cirujanos y de los pacientes fue registrada en escala de 4 puntos. RESULTADOS: Los valores de BIS y de la Evaluación del Observador de Guardia (OAA/S) fueron menores en el Grupo P que en el Grupo S. La satisfacción de los pacientes fue mayor en el Grupo P, aunque no haya habido diferencia significativa con relación a la satisfacción de los cirujanos entre los grupos. El número de solicitaciones de sedación fue significativamente mayor en el Grupo S. Sin embargo, la mayoría de las solicitaciones no fue considerada exitosa. CONCLUSIONES: Este estudio sugiere que la analgesia controlada por el paciente con el uso de propofol puede ser usada con resultados eficaces en procedimientos ortopédicos.

Pre-emptive analgesic and haemodynamic efficacy of combined spinal-epidural neostigmine delivery.

OBJECTIVE: To determine the effect of pre-emptive epidurally administered 4 or 8 mcg/kg neostigmine on analgesia, mean arterial pressure, heart rate and side effects in intra and postoperative period. STUDY DESIGN: Randomized, double blinded, controlled clinical trial. PLACE AND DURATION OF STUDY: Ankara Numune Training and Research Hospital, Turkey, from January to December 2008. METHODOLOGY: Forty-five patients scheduled for lower extremity surgery were included in the study following the approval of the ethics committee and the patients. The study group was split into three groups and received combined spinalepidural anaesthesia. Diluting with 10 ml normal saline, group N4 and group N8 were delivered 4 mcg/kg and 8 mcg/kg epidural neostigmine, respectively, whereas group SF received 10 ml epidural saline. Lidocaine (2%) at 1.2 mg/kg dose was preferred for spinal anaesthesia. Analgesic efficacy, time to first analgesic requirement, Visual Analog Scale, Fentanyl consumption in the postoperative patient-controlled epidural analgesia, and delivered/required number of boluses, were evaluated. Haemodynamic data and side effects were noted. RESULTS: Statistically, analgesic consumptions at 12 and 24 hours in the N8 group was lower than those in the SF group, the number of delivered boluses was lower in the N8 group compared with the SF and N4 groups, number of required boluses was lower in the N8 group than in the SF group. In terms of haemodynamics and side effects, no difference was found between the groups regarding the entire intraoperative and postoperative parameters. CONCLUSION: Epidural Neostigmine administration at 8 mcg/kg was found to be a viable additional agent against analgesia, with the postoperative period depending on the dosage.

Characteristics of unilateral spinal anesthesia at different speeds of intrathecal injection.

PURPOSE: Unilateral spinal anesthesia is performed to provide restriction of sympathetic and motor block. The purpose of this study is to compare the effect of different speeds of intrathecal injection on unilateral spinal anesthesia. METHODS: The patient cohort comprised 66 patients who were placed in the lateral position with the side to be operated on dependent. After dural puncture, the needle aperture was turned towards the dependent side, and hyperbaric 0.5% bupivacaine was injected at a rate of 1 ml/min in Group Slow patients (Group S, n = 33) or 0.5 ml/min in Group Extra Slow patients (Group ES, n = 33). The lateral position was maintained for 15 min. Skin temperature, loss of pinprick sensation, and degree of motor block were recorded. RESULTS: There were significant differences in the characteristics of the non-operative side between the groups when on the block. Sensorial block was unilateral in 25 (75.8%) patients in Group S and in 29 patients in Group ES (87.9%) 15 min post-injection. At the end of the operation (approximately 50 min after spinal anesthesia), strictly unilateral anesthesia was present in 31 patients in Group ES (93.9%) and in 22 patients in Group S (66.6%) (p < 0.05). Unilateral sensory and motor block were observed in both groups, and the incidence of strict unilateral block was significantly higher in group ES patients. CONCLUSIONS: The result of the study show that the extra-slow injection of hyperbaric bupivacaine provided strictly unilateral sensorial and sympathetic block in 93.9 and 87.9% of the patients, respectively, and that a slow injection of low doses of hyperbaric 0.5% bupivacaine 1 ml was sufficient to provide unilateral spinal anesthesia.

Low-dose ropivacaine or levobupivacaine walking spinal anesthesia in ambulatory inguinal herniorrhaphy.

PURPOSE: The purpose of our study was to compare the equipotent doses of ropivacaine and levobupivacaine for walk-out criteria and the characteristics of spinal anesthesia in inguinal herniorrhaphy surgery. METHODS: Combined spinal-epidural anesthesia was performed. Adult patients were randomly allocated to receive 5 mg 0.5% ropivacaine plus 25 µg fentanyl (group RF, n = 25) or 3.75 mg 0.75% levobupivacaine plus 25 µg fentanyl (group LF, n = 25). Each solution was hypobaric, and the same volume, 3 ml, was administered. Sensory and motor block characteristics, hemodynamic changes, side effects, number of patients having ability to stand and walk at the end of the operation, time to first analgesic requirement, time to urination, time to getting out of bed (ambulation), and time to home discharge were determined. RESULTS: Sensory block onset time and time to reach the T6 dermatome were significantly shorter in group LF, whereas time to the two-segment regression and time to first analgesic requirement were significantly shorter in group RF. All patients in group LF were Bromage 0. Time to home discharge was shorter in group LF, but this difference was not statistically significant. CONCLUSION: We suggest that both local anesthetics can be used in walking spinal technique. Levobupivacaine may be an alternative local anesthetic for walking spinal anesthesia as it provides minimum motor block and a long duration of postoperative analgesia, even if its use is not associated with a shorter home discharge time.

Comparison of 0.25% levobupivacaine and 0.25% bupivacaine for posterior approach interscalene brachial plexus block.

PURPOSE: This study compares the onset time and quality of posterior approach interscalene brachial plexus block produced by 0.25% levobupivacaine and 0.25% bupivacaine. METHODS: Sixty adult patients undergoing open or closed shoulder surgery were enrolled in this double-blind, randomized study, and they were randomly allocated to receive 40 ml of 0.25% levobupivacaine (Group L, n = 30) or 0.25% bupivacaine (Group B, n = 30). The patients were assessed at 5 min intervals after local anesthetic injection in order to determine loss of shoulder abduction and loss of pinprick sensation in the C(5-6) dermatomes. The mean onset time of motor and sensory block and onset time of complete motor and sensory block were documented in both groups. RESULTS: In both groups, mean onset time of sensory block was <5 min and mean onset time of complete sensory block was <25 min. The onset times for sensory block and complete sensory block were not statistically different between the groups (P > 0.05). In both groups, mean onset time of motor block was <10 min but the mean onset time of complete motor block was <30 min. The onset times of motor block and complete motor block were not statistically different among the groups (P > 0.05). After the injection of the local anesthetic, 27% of Group L and 87% of Group B had complete motor block. Four patients in Group L had no motor block. CONCLUSION: We conclude that 0.25% levobupivacaine and 0.25% bupivacaine have similar motor and sensory block onset times and qualities when used in posterior approach interscalene brachial plexus block, and provide comfortable anesthesia and analgesia for shoulder surgery.

Selective spinal anesthesia for inguinal herniorrhaphy.

OBJECTIVE: To determine the characteristic profiles of 2 hypobaric spinal anesthetic solutions for selective spinal anesthesia in inguinal herniorrhaphy. METHODS: The study took place in the general surgery room of Anesthesia Department, Ankara Numune Research and Training Hospital between May and July 2005 as a prospective, randomized and double-blind trial. Sixty-one ASA I-III patients scheduled for inguinal herniorrhaphy were randomly divided into 2 groups. Group R received combined spinal epidural anesthesia with ropivacaine 7.5 mg and group B received bupivacaine 5 mg; in both groups 25 ug of fentanyl was added. Solutions were diluted with 1.5 ml of sterile water. A Portex 18/27 or 16/27 needle was inserted at L1-2 or L2-3 with patients sitting upright; surgery began after the sensory block reached the T6 dermatome. Sensory and motor block characteristics, hemodynamic data, side effects, recovery time, the timing of the onset of pain, and the walkout were assessed. RESULTS: Motor block duration was shorter in Group R (56.1 +/- 36.1 minutes versus 72.5 +/- 23.3 minutes) (p=0.013). Complete motor block duration was shorter in Group R. There was no difference between the 2 groups. Intra-group analysis showed that hemodynamic values after anesthesia induction were lower than initial values. CONCLUSION: Ropivacaine plus fentanyl provided similar sensory anesthesia, but with a shorter duration of motor block than bupivacaine plus fentanyl when used for selective spinal anesthesia in herniorrhaphy surgery. Furthermore, we suggest that hemodynamic should be carefully monitored during surgery.

Anesthesia for laparoscopic cholecystectomy: comparative evaluation--desflurane/sevoflurane vs. propofol.

Laparoscopic techniques, have rapidly increased in popularity because of its various benefits. They are widely used in day-case surgical operations and are extensively published. However, postoperative nausea vomiting (PONV) is a commonly observed phenomenon after laparoscopic procedures. Its occurrence may increase depending on the anesthetic techniques used. Despite the fact that the use of propofol and the new low solubility inhalation anesthetics, lead to faster induction and recovery, their effects on PONV is not sufficiently known. Therefore, the aim of this study is to compare the effects of various anesthetic drugs on recovery characteristics and PONV. Following informed consent, 300 ASA I-III patients scheduled for laparoscopic cholecystectomy were investigated. Anesthesia was induced by 1.5 microgkg(-1) fentanyl, 0.03 mgkg(-1) midazolam, 1.5 mgkg(-1) propofol and 0.01 mgkg(-1) vecuronium for all patients. Anesthesia was maintained with desflurane in group D (n = 100), sevoflurane in group S (n = 100) and propofol infusion in group P (n = 100), beside 50% N20/O2 ventilation. All patients were given 4 mg ondansetron and 8 mg dexamethazone iv for preventing PONV, ten minutes before the end of surgery. At the end of the operation, times for extubation, eye opening, orientation, sitting and walking, and the need of ondansetrone in post anesthetic care unit, were recorded. Also, PONV was observed and recorded as early period (first 4 hours) and late period (4-24 hours). Extubation and eye opening times were meaningfully lower in group D. However, no significant differences were observed in orientation, sitting and walking times and PONV among the three groups. All patients who had PONV were women. A correlation was found between PONV and body weight. Even though there were no statistically significant differences among the groups regarding PONV, the number of patients who had PONV in group P was lower. Early recovery time was shortest in group D, while delayed recovery time had no differences. It may be said that these anesthetic drugs have no statistically significant difference for PONV and delayed recovery.

The use of ketamine or ketamine-midazolam for adenotonsillectomy.

BACKGROUND: Ketamine's role in clinical anaesthesia is developing as a result of the evolving concepts of its mechanism of action and the advantages of its alternative routes of administration. In this study, we aimed to investigate the frequency and severity of adverse effects, specifically emergence phenomena and vomiting, when ketamine with or without midazolam used as a sole anaesthetic. METHODS: One hundred children, aged between 3 and 10 years, scheduled for adenotonsillectomy were studied. Fifty ASA physical status I-II patients were administered ketamine and atropine intramuscularly (group K, n=50). The remaining 50 children were given ketamine, atropine and midazolam by as the same route (group KM, n=50). Noninvasive hemodynamic and oxygenation variables were monitored. Operative conditions and recovery profiles such as hallucinations, nightmares, awakening by crying agitation and retching-vomiting were investigated in 1st, 2nd, 15th, 30th and 60th days after the operation. RESULTS: A significant reduction in emergence reactions was demonstrated especially in group KM during the early postoperative period (p<0.05). Retching-vomiting also reduced significantly in the group KM during the same time (p<0.05). CONCLUSION: As a sole anaesthetic ketamine with or without midazolam provided a calm and safe anaesthesia for paediatric patients in short term procedures. In addition, it must be noted that, a better postoperative early period was achieved by ketamine with midazolam.

Neuroaxial anesthesia in a patient with progressive systemic sclerosis : case presentation and review of the literature on systemic sclerosis.

BACKGROUND: Systemic sclerosis (SSc), a progressive disease characterized by excessive accumulation of connective tissue components. Although most patients have long survival, some of them progress rapidly to death. Pulmonary system involvement and pulmonary hypertension are the most frequent cause of death. When the patient with SSc is to be operated, the anesthetic procedure could be a serious problem. In this article, we report a combined spinal--epidural technique in a patient with progressive SSc and the anesthetic considerations that could be recommended for these patients. CASE PRESENTATION: A 68-year-old woman who had a history of progressive systemic sclerosis, pulmonary fibrosis, kyphoscoliosis and decreased oral apertura underwent total hip arthroplasty. This operation was performed successfully under combined spinal epidural anesthesia. CONCLUSION: Systemic sclerosis is a complex disease that involves multiple organ systems. Every aspects of anesthetic care may be altered or hindered by the pathogenesis of disease. Although the choice of regional or general anesthesia is unclear, to choose combined spinal epidural anesthesia may be useful.