Efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in infants undergoing lobectomy under general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.Methods Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes,aged 1-3 yr,weighing 10-16 kg,scheduled for elective lobectomy under general anesthesia,were divided into 2 groups (n =30 each) using a random number table method:control group (group C) and epidural block group (group E).Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E.An epidural catheter was inserted at T6,7 interspace,0.1％ ropivacaine 1 mg/kg was injected at 5 min after injecting 1％ lidocaine 3 ml,the diffusion of epidural fluid was controlled at T3-10,and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score＞3,the pump was pressed.When pain was still unrelieved 5 min later,sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation,and the requirement for additional remifentanil and sufentanil,and the occurrence of postoperative nausea and vomiting,respiratory depression,hypoxemia and over-sedation was recorded.The number of pressing times,extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents.Results Compared with group C,the consumption of remifentanil,the number of pressing times and requirement for additional sufentanil were significantly decreased,the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery,the extubation time and duration of intensive care unit stay were shortened,and the incidence of nausea and vomiting and over-sedation was decreased in group E (P＜0.05).Conclusion Uhrasound-gnided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in infants undergoing lobectomy under general anesthesia / 中华麻醉学杂志

Objective@#To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.@*Methods@#Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T6, 7 interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents.@*Results@#Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05).@*Conclusion@#Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Efficacy of ultrasound-guided serratus anterior plane block for postoperative analgesia in patients undergoing thorascopic surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective thoracoscopic surgery under general anesthesia,were divided into 3 groups (n=20 each) using a random number table method:control group (group C),thoracic paravertebral block (PVB) group (group PVB) and group SAPB.After the patients were turned to contralateral position,thoracic PVB was performed at T4.6 thoracic vertebrae on the affected side under ultrasound guidance,and 0.25％ ropivacaine 20 ml was injected in group PVB.In group SAPB,ultrasoundguided SAPB was performed on the affected side,and 0.33％ ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores＞3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing,total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded,the dose was calculated,and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting,pulmonary infection and chronic pain was also recorded.Results Compared with group C,the consumption,dose and total consumption of sufentanil were significantly decreased,the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased,and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P＜0.05).Compared with group PVB,no significant change was found in the parameters in group SAPB (P＞0.05).There was no significant difference in the incidence of chronic pain among the three groups (P＞0.05),and no patients required additional flurbiprofen axetil.Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects.

Efficacy of ultrasound-guided adductor canal block for analgesia after tibial fracture / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided adductor canal block (ACB) for analgesia after tibial fracture.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective internal fixation for unilateral tibial fracture under general anesthesia,were enrolled in this study.The tracheal tube was removed after operation,and then the patients were admitted to the postanesthesia care unit.The visual analog scale score was recorded.Eighty patients with visual analog scale score＞3 were divided into 2 groups (n =40 each) using a random number table method:control group (group C) and ACB group.Patient-controlled intravenous analgesia (PCIA) was performed at the end of operation.Patients underwent ACB on the affected side,and 0.375％ ropivacaine 20 ml was injected in group ACB.Sufentanil 0.1-0.2 μg/kg was intravenously injected in group C.Ramsay sedation scores were recorded immediately after entering the postanesthesia care unit (T0) and at 15 and 30 min and 1,2,4,8 12 and 24 h after block (T1-8).When visual analog scale scores ＞3 points and the pain could not be relieved through pressing the PCA pump,tramadol 1-2 mg/kg was intramuscularly injected.Patients were followed up for 24 h after surgery,and the postoperative consumption of sufentanil,pressing time of PCA and patients' satisfaction scores were recorded.The occurrence of postoperative nausea and vomiting,respiratory depression and hypoxemia and length of postoperative hospital stay were also recorded.Results Compared with group C,the postoperative consumption of sufentanil,pressing time of PCA,requirement for and consumption of tramadol,incidence of postoperative nausea and vomiting and oversedation,and Ramsay sedation score at T1-5 were significantly decreased,and the patients' satisfaction score were increased in group ACB (P＜0.05).Conclusion Ultrasound-guided ACB exerts better analgesic efficacy after tibial fracture with fewer adverse reactions.

Patient Satisfaction And Cost Analysis Of Analgesia Management For Post-Operative Procedures In Htaa: Pca Vs. Conventional Method

@#Acute pain service (APS) offer several techniques to the post-operative patient in controlling and relieving the pain such as intravenous infusion, patient-controlled analgesia, epidural infusion, subcutaneous or intramuscular injection and intrathecal administration. The effectiveness of and satisfaction towards APS is not clearly defined. Therefore, the aim of this study is to conduct the cost analysis and comparison between these techniques and patient satisfaction. The study design for cost analysis was retrospective study. The means of the data were calculated based on Integration Store of Hospital Tengku Ampuan Afzan records. In addition, the evaluation of patient’s satisfaction was conducted by using a cross-sectional study design. The mean of the data was calculated and analysed by using Chi-square test. The total cost required to prepare PCA for post-operative patient was the highest with RM 8810.98. Meanwhile, the cost for subcutaneous morphine injection, epidural infusion and peripheral block injection were RM 2.11, RM 5323.95 and RM 4.95 respectively. However, when taking into the aspect of patient’s satisfaction, PCA has the highest level of excellent performance with 54.6% compare to EDA (33%) and BLOCK (12.4%) with the p-value is less than 0.05. In conclusion, every drug has its own side effects. As the healthcare provider, it is a need to ensure drugs that were given to the patients are at the very minimum risk of having the side effects. Based on the findings of this study, it could be said that both drugs have lower percentage of people experienced the side effect after treated with the drugs. Therefore, the future study should be more focusing on the side effect of the drugs used. In terms of cost spent for the methods, the PCA regimen is more likely expensive compared to the conventional methods. However, based on survey among the patients, PCA-treated patients expressed higher satisfaction compared to the conventional regimen of pain management.

Effect of Eptazocine Hydrobromide Combined with Sufentanil on Postoperative Analgesia After Trans-urethral Resection Prostate / 医药导报

Objective To explore effect of eptazocine hydrobromide combined with sufentanil on postoperative analgesia after trans-urethral resection prostate ( TURP ). Methods One hundred and twenty adult patients undergoing TURP were randomly divided into three groups ( n＝40): eptazocine hydrobromide group ( group E), dezocine combined with sufentanyl group (group DS) and eptazocine hydrobromide combined with sufentanyl group (group ES).All patients received postoperative patient controlled intravenous analgesia (PCIA).The patients in the group E were given eptazocine hydrobromide with dose of 1 mg·kg-1;group DS patients were given with dezocine of 0. 3 mg·kg-1combined with sufentanil 1. 5 μg·kg-1;group ES patients were given eptazocine hydrobromide 0.2 mg·kg-1combined with sufentanil 1.5 μg·kg-1.The VAS scores and Ramsay scores were recorded at 1 h (t1), 4 h (t2),8 h (t3), 12 h (t4), 24 h (t5) and 48 h (t6) postoperatively.Total analgesic consumption of PCIA pump and total need of remedial drugs, the incidences of postoperative dizziness, nausea and vomiting, and other adverse reactions during postoperative 48 h were also documented. Results Compared with group E, VAS scores at each time point postoperatively in group DS and group ES were lower (P<0.05);and total analgesic consumption of PCIA pump and total need of remedial drugs were also lower than group E(P<0.05);the incidence of vertigo, nausea and vomiting, dysphoria, drowsiness in group DS were higher(P<0.05);while only the incidence of nausea and vomiting in group ES was higher than group E (P<0.05).Compared with group DS, no statistical significances of VAS scores were found at each time point postoperatively between group DS and group ES (P>0.05);but total analgesic consumption of PCIA pump and the need of remedial drugs in group ES were lower (P<0.05);patients in group ES with lower incidence of respiratory depression, vertigo, dysphoria and drowsiness ( P< 0. 05 ). No statistical significances were found when comparing the Ramsay scores at each time point postoperatively among three groups (P>0.05). Conclusion Eptazocine hydrobromide combined with sufentanyl can effectively alleviate the postoperative pain in patients with TURP, reduce the consumption of postoperative analgesics and incidence of analgesic related adverse reactions.

Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia.

BACKGROUND: The aim of this study was to examine if gradual withdrawal of remifentanil infusion prevented opioid-induced hyperalgesia (OIH) as opposed to abrupt withdrawal. OIH duration was also evaluated. METHODS: Nineteen volunteers were enrolled in this randomized, double-blinded, placebo-controlled, crossover study. All went through three sessions: abrupt or gradual withdrawal of remifentanil infusion and placebo. Remifentanil was administered at 2.5 ng ml(-1) for 30 min before abrupt withdrawal or gradual withdrawal by 0.6 ng ml(-1) every five min. Pain was assessed at baseline, during infusion, 45-50 min and 105-110 min after end of infusions using the heat pain test (HPT) and the cold pressor test (CPT). RESULTS: The HPT 45 min after infusion indicated OIH development in the abrupt withdrawal session with higher pain scores compared with the gradual withdrawal and placebo sessions (both P<0.01. Marginal mean scores: placebo 2.90; abrupt 3.39; gradual 2.88), but no OIH after gradual withdrawal compared with placebo (P=0.93). In the CPT 50 min after end of infusion there was OIH in both remifentanil sessions compared with placebo (gradual P=0.01, abrupt P<0.01. Marginal mean scores: placebo 4.56; abrupt 5.25; gradual 5.04). There were no differences between the three sessions 105-110 min after infusion. CONCLUSIONS: We found no development of OIH after gradual withdrawal of remifentanil infusion in the HPT. After abrupt withdrawal OIH was present in the HPT. In the CPT there was OIH after both gradual and abrupt withdrawal of infusion. The duration of OIH was less than 105 min for both pain modalities. CLINICAL TRIAL REGISTRATION: NCT 01702389. EudraCT number 2011-002734-39.

Pain management in pigs undergoing experimental surgery; a literature review (2012-4).

Failure to provide effective analgesia to animals in noxious studies contravenes the obligation to refine animal experimentation and, by increasing 'noise' in physiological data sets, may decrease the scientific validity of results. Pig models of surgical conditions are becoming increasingly important and used for translational work. This review aimed to determine the extent to which the recent biomedical literature describes pain assessment and alleviation in pigs recovering from experimental surgery. Three databases (Medline, Web of Knowledge, and Google Scholar) were searched to find relevant studies published from January 2012 to March 2014. Information on pain assessment and peri- and postoperative analgesia was extracted. The review identified 233 papers meeting selection criteria. Most articles (193/233, 83%) described use of drugs with analgesic properties, but only 87/233 (37%) described postoperative analgesia. No article provided justification for the analgesic chosen, despite the lack of guidelines for analgesia in porcine surgical models and the lack of formal studies on this subject. Postoperative pain assessment was reported in only 23/233 (10%) articles. It was found that the reporting of postoperative pain management in the studies was remarkably low, reflecting either under-reporting or under-use. Analgesic description, when given, was frequently too limited to enable reproducibility. Development of a pain-scoring system in pigs, together with the mandatory description of pain management in submitted articles, would contribute to improved laboratory pig welfare.

Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy.

BACKGROUND: Epidural administration of dexamethasone might reduce postoperative pain in adults. We evaluated whether a caudal block of 0.1 mg kg(-1) dexamethasone combined with ropivacaine improves analgesic efficacy in children undergoing day-case orchiopexy. METHODS: This randomized, double-blind study included 80 children aged 6 months to 5 yr who underwent day-case, unilateral orchiopexy. Patients received either 1.5 ml kg(-1) of 0.15% ropivacaine (Group C) or 1.5 ml kg(-1) of 0.15% ropivacaine in which dexamethasone of 0.1 mg kg(-1) was mixed (Group D) for caudal analgesia. Postoperative pain scores, rescue analgesic consumption, and side-effects were evaluated 48 h after operation. RESULTS: Postoperative pain scores at 6 and 24 h post-surgery were significantly lower in Group D than in Group C. Furthermore, the number of subjects who remained pain free up to 48 h after operation was significantly greater in Group D [19 of 38 (50%)] than in Group C [four of 37 (10.8%); P<0.001]. The number of subjects who received oral analgesic was significantly lower in Group D [11 of 38 (28.9%)] than in Group C [20 of 37 (54.1%); P=0.027]. Time to first oral analgesic administration after surgery was also significantly longer in Group D than in Group C (P=0.014). Adverse events after surgery including vomiting, fever, wound infection, and wound dehiscence were comparable between the two groups. CONCLUSIONS: The addition of dexamethasone 0.1 mg kg(-1) to ropivacaine for caudal block can significantly improve analgesic efficacy in children undergoing orchiopexy. Clinical trial registration NCT01604915.

Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis.

BACKGROUND: Both posterior and lateral transversus abdominis plane (TAP) block techniques provide effective early (0-12 h) postoperative analgesia after transverse incision surgery. However, whether either technique produces prolonged analgesia lasting beyond 12 h remains controversial. This meta-analysis examines the duration of analgesia associated with posterior and lateral TAP blocks in the first 48 h after lower abdominal transverse incision surgery. METHODS: We retrieved randomized controlled trials (RCTs) investigating the analgesic effects of TAP block compared with control in patients undergoing lower abdominal transverse incision surgery. Outcomes sought included interval postoperative i.v. morphine consumption and also rest and dynamic pain scores at 12, 24, 36, and 48 h postoperatively. Opioid-related side-effects and patient satisfaction at 24 and 48 h were also assessed. The 12-24 h interval morphine consumption was designated as a primary outcome. RESULTS: Twelve RCTs including 641 patients were analysed. Four trials examined the posterior technique and eight assessed the lateral technique. Compared with control, the posterior TAP block reduced postoperative morphine consumption during the 12-24 h and 24-48 h intervals by 9.1 mg (95% CI: -16.83, -1.45; P=0.02) and 5 mg (95% CI: -9.54, -0.52; P=0.03), respectively. It also reduced rest pain scores at 24, 36, and 48 h, and also dynamic pain scores at 12, 24, 36, and 48 h. Differences were not significant with the lateral TAP block. CONCLUSION: Based on the comparisons with control, the posterior TAP block appears to produce more prolonged analgesia than the lateral TAP block. Future RCTs comparing these two techniques are required to confirm our findings.

Analgesia nociception index: evaluation as a new parameter for acute postoperative pain.

BACKGROUND: A means of identifying the presence and severity of pain that is not reliant on the subjective assessment of pain is desirable whenever a patient self-rating of pain cannot be easily obtained (e.g. sedated patients, very young children, individuals with learning difficulties). The heart rate variability based analgesia nociception index (ANI) has been proposed to reflect different levels of acute pain. The aim of this study was to compare ANI scores with a numeric rating scale (NRS, 0-10) based on self-assessment of pain in the recovery room. METHODS: One hundred and twenty patients after non-emergency surgery were included. On arrival in the post-anaesthesia care unit (PACU) and subsequently at 5 min intervals, patients were asked to rate their level of pain on a 0-10 NRS. ANI values 0-100 points (low values indicating higher levels of pain) were recorded simultaneously. RESULTS: Eight hundred and sixteen pain ratings from 114 patients were included in the analysis. A small but statistically significant negative correlation was found between ANI and the NRS scores (ρ=-0.075; P=0.034). A small but significant difference in ANI was found comparing the extremes of pain [mean (se): NRS 0: 63 (1.4) vs NRS 6-10: 59 (1.4); P=0.027]. However, a receiver-operating analysis testing the value of ANI to distinguish between NRS 0 and NRS 6-10 revealed only low sensitivity and specificity. CONCLUSION: ANI did not reflect different states of acute postoperative pain measured on a NRS scale after adult sevoflurane-based general anaesthesia.

Plasma ropivacaine concentrations during bilateral transversus abdominis plane infusions.

BACKGROUND: The transversus abdominis plane (TAP) block is a regional anaesthetic technique that blocks abdominal wall somatic afferent nerves. We conducted a prospective observational study to evaluate the venous plasma concentrations of ropivacaine during a continuous TAP infusion. METHODS: Twenty patients who were planned to undergo intra-abdominal cavity surgery requiring a mid-line laparotomy incision were enrolled. Patients were excluded if they had a history of chronic pain, opioid tolerance, renal or hepatic impairment, or contraindication to study medications. Subjects received a standardized general anaesthetic, and at the completion of surgery, ultrasound-guided subcostal or posterior TAP blocks and catheters. A TAP infusion of 2 mg ml(-1) ropivacaine was administered for 72 h after operation. Data collection during the 72 h included morphine requirements, pain scores, and plasma ropivacaine levels. RESULTS: TAP blocks and catheters were successfully inserted in all recruited subjects. The fourth subject experienced neurological symptoms attributed to local anaesthetic toxicity, but did not have high plasma ropivacaine concentrations. However, the protocol was amended for the subsequent 16 subjects, to a weight-based dosing regimen. The range of total plasma ropivacaine concentrations was 0.98-3.41 mg litre(-1) for posterior infusions and 0.96-3.48 mg litre(-1) for subcostal infusions. Four subjects had total ropivacaine levels >3.4 mg litre(-1). The range of unbound plasma ropivacaine concentrations was 0.022-0.135 mg litre(-1) for posterior infusions and 0.031-0.120 mg litre(-1) for subcostal infusions. CONCLUSION: Given the potential for high plasma concentrations from a bilateral TAP infusion technique, attention should be paid to individualized dosing strategies.

I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study.

BACKGROUND: Interscalene brachial plexus block (ISB) provides excellent, but time-limited analgesia. Dexamethasone added to local anaesthetics prolongs the duration of a single-shot ISB. However, systemic glucocorticoids also improve postoperative analgesia. The hypothesis was tested that perineural and i.v. dexamethasone would have an equivalent effect on prolonging analgesic duration of an ISB. METHODS: We performed a prospective, double blind, randomized, placebo-controlled study. Patients presenting for arthroscopic shoulder surgery with an ISB were randomized into three groups: ropivacaine 0.5% (R); ropivacaine 0.5% and dexamethasone 10 mg (RD); and ropivacaine 0.5% with i.v. dexamethasone 10 mg (RDiv). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first analgesic request. Standard hypothesis tests (t-test, Mann-Whitney U-test) were used to compare treatment groups. The primary outcome was analysed by Kaplan-Meier survival analysis with a log-rank test and Cox's proportional hazards regression. RESULTS: One hundred and fifty patients were included after obtaining ethical committee approval and patient informed consent. The median time of a sensory block was equivalent for perineural and i.v. dexamethasone: 1405 min (IQR 1015-1710) and 1275 min (IQR 1095-2035) for RD and RDiv, respectively. There was a significant difference between the ropivacaine group: 757 min (IQR 635-910) and the dexamethasone groups (P<0.0001). CONCLUSIONS: I.V. dexamethasone is equivalent to perineural dexamethasone in prolonging the analgesic duration of a single-shot ISB with ropivacaine. As dexamethasone is not licensed for perineural use, clinicians should consider i.v. administration of dexamethasone to achieve an increased duration of ISB.

Avaliação do efeito da cetamina associada à remifentanila na dor pós-operatória / Assessment of the effect of ketamine in combination with remifentanil on postoperative pain / Evaluación del Efecto de la Cetamina Asociada con el Remifentanilo en el Dolor Postoperatorio

JUSTIFICATIVA E OBJETIVOS: A associação de cetamina com remifentanila parece estar relacionada à analgesia de melhor qualidade e duração. O objetivo deste estudo foi avaliar se a cetamina associada à remifentanila promove melhora da analgesia pós-operatória. MÉTODO: Estudo prospectivo, aleatório, duplo encoberto em 40 pacientes submetidos à colecistectomia videolaparoscópica. A anestesia foi feita com remifentanila, propofol, atracúrio, 50% de oxigênio. Os pacientes do G1 receberam remifentanila (0,4 mcg.kg-1.min-1) e cetamina (5 mcg.kg-1.min-1); os do G2, remifentanila (0,4 mcg.kg-1.min-1) e solução salina. Foi administrado 0,1 mg.kg-1 de morfina no final da operação e a dor pós-operatória foi tratada com morfina, através de analgesia controlada pelo paciente (PCA). A intensidade da dor pós-operatória foi avaliada pela escala numérica de 0 a 10, durante 24 horas. Foram anotados o tempo para primeira complementação analgésica, a quantidade de morfina usada durante 24 horas e os efeitos adversos. RESULTADOS: Ocorreu diminuição da intensidade da dor entre a desintubação e os outros momentos avaliados no G1 e no G2. Não foi observada diferença significante na intensidade da dor entre os grupos. Não houve diferença entre G1 (22 ± 24,9 min) e G2 (21,5 ± 28,1 min) no tempo para a primeira dose de morfina e dose complementar de morfina consumida no G1 (29 ± 18,4 mg) e no G2 (25,1 ± 13,3 mg). CONCLUSÕES: A associação de cetamina (5 mcg.kg-1.min-1) a remifentanila (0,4 mcg.kg-1.min-1) para colecistectomia não alterou a intensidade da dor pós-operatória, o tempo para primeira complementação ou a dose de morfina em 24 horas.

BACKGROUND AND OBJECTIVES: The combination of ketamine and remifentanil seems to be associated with better analgesia and duration. The aim of this study was to evaluate whether a ketamineremifentanil combination promotes improved postoperative analgesia. METHODS: Prospective, randomized, double blind study of 40 patients undergoing video laparoscopic cholecystectomy. Anesthesia was performed with remifentanil, propofol, atracurium, and 50% oxygen. Group 1 (GI) patients received remifentanil (0.4 mcg.kg-1.min-1) and ketamine (5 mcg.kg-1.min-1) and Group 2 (G2) received remifentanil (0.4 mcg.kg-1.min-1) and saline solution. Morphine 0.1 mg.kg-1 was administered at the end of the procedure, and postoperative pain was treated with morphine via PCA. We evaluated the severity of postoperative pain by a numerical scale from zero to 10 during 24 hours. We registered the time to the first analgesic supplementation, amount of morphine used in the first 24 hours, and adverse effects. RESULTS: There was a decrease in pain severity between extubation and other times evaluated in G1 and G2. There was no significant difference in pain intensity between the groups. There was no difference between G1 (22 ± 24.9 min) and G2 (21.5 ± 28.1 min) regarding time to first dose of morphine and dose supplement of morphine consumed in G1 (29 ± 18.4 mg) and G2 (25.1 ± 13.3 mg). CONCLUSION: The combination of ketamine (5 mcg.kg-1.min-1) and remifentanil (0.4 mcg.kg-1.min-1) for cholecystectomy did not alter the severity of postoperative pain, time to first analgesic supplementation or dose of morphine in 24 hours.

JUSTIFICATIVA Y OBJETIVOS: La asociación de la cetamina con el Remifentanilo parece estar asociada con una analgesia de mejor calidad y duración. El objetivo de este estudio fue evaluar si la cetamina asociada al Remifentanilo genera una mejoría de la analgesia postoperatoria. MÉTODO: Se hizo un estudio prospectivo, aleatorio y doble ciego en 40 pacientes sometidos a la colecistectomía videolaparoscópica. La anestesia se realizó con de Remifentanilo, propofol, atracurio y 50% de oxígeno. Los pacientes del G1 recibieron Remifentanilo (0,4 mcg.kg-1.min-1) y cetamina (5 mcg.kg-1.min-1); los del G2, Remifentanilo (0,4 mcg.kg-1.min-1) y solución salina. Fue administrado 0,1 mg.kg-1 de morfina al final de la operación y el dolor postoperatorio se trató con morfina por medio de analgesia controlada por el paciente (PCA). La intensidad del dolor postoperatorio fue mensurada por la escala numérica de 0 a 10, durante 24h. Se anotó el tiempo para la primera complementación analgésica, la cantidad de morfina utilizada durante 24 h y los efectos adversos. RESULTADOS: Ocurrió una reducción de la intensidad del dolor entre el momento de la desentubación y los otros momentos calculados en el G1 y en el G2. No fue observada ninguna diferencia significativa en la intensidad del dolor entre los grupos. No hubo diferencia entre G1 (22 ± 24,9 min.) y G2 (21,5 ± 28,1 min.) en el tiempo para la primera dosis de morfina y dosis complementaria de morfina consumida en el G1 (29 ± 18,4 mg) y en el G2 (25,1 ± 13,3 mg). CONCLUSIONES: La asociación de la cetamina (5 mcg.kg-1.min-1) con el Remifentanilo (0,4 mcg.kg-1.min-1) para la colecistectomía no alteró la intensidad del dolor postoperatorio, el tiempo para la primera complementación o la dosis de morfina en 24h.

Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho / Analgesic efficacy of the intra-articular administration of high Doses of morphine in patients undergoing total knee arthroplasty / Eficacia analgésica del uso de dosis alta de morfina intra-articular en pacientes sometidos a la artroplastia total de rodilla

Justificativa e objetivos: Apesar da eficácia da morfina intraarticular (IA) permanecer controversa, tem-se mostrado que doses maiores promovem melhores resultados e, consequentemente, menor consumo pós-operatório de analgésico, caracterizando, assim, efeito dose-dependente na ação periférica. Foi conduzido estudo controlado, aleatório e duplamente encoberto para avaliar a eficácia de 10 mg de morfina por via intra-articular em pacientes submetidos à artroplastia total de joelho. Método: Foram avaliados 50 pacientes submetidos à artroplastia total de joelho, distribuídos aleatoriamente em dois grupos: o grupotratamento recebeu 10 mg (1 mL) de morfina por via intra-articular diluído em 19 mL de solução fisiológica a 0,9 por cento (SF), enquanto o grupo-controle recebeu injeção intra-articular contendo 20 mL de SF, ambos após o fechamento da cápsula articular, ao final da operação. Morfina subcutânea sob demanda esteve disponível para dor residual. As seguintes variáveis foram avaliadas: intensidade da dor graduada na Escala Numérica (EN) às 2 h (M1), 6 h (M2), 12 h (M3) e 24 h (M4) após injeção IA; tempo para primeira solicitação de analgésico; consumo de analgésicos e efeitos adversos. Conclusões: O grupo-tratamento apresentou menores valores na EN que o grupo-controle em M1 e M2, enquanto que nos outros momentos não houve diferença significativa. O intervalo para primeira solicitação de analgésicos foi significativamente maior no grupo tratamento e o consumo de analgésicos nas primeiras 24 horas foi menor neste grupo. Não houve diferença entre incidência de efeitos adversos entre os grupos. Concluiu-se que 10 mg de morfina reduziram dor pós-operatória 2 e 6 horas após injeção IA, promoveram maior período sem analgésico de resgate e reduziram seu consumo nas primeiras 24 horas.

Background and objectives: Although the efficacy of intraarticular (IA) morphine is still controversial, it has been shown that higher doses promote better results and consequently decrease postoperative analgesic consumption, characterizing a dose-dependent peripheral action. A controlled, randomized, double-blind study was undertaken to evaluate the efficacy of the intra-articular administration of 10 mg of morphine in patients undergoing total knee arthroplasty. Methods: Fifty patients undergoing total knee arthroplasty were randomly divided into two groups: the treatment group received 10 mg (1 mL) of intra-articular morphine diluted in 19 mL of NS, while the control group received the intra-articular administration of 20 mL of NS, both after closure of the capsule at the end of the surgery. On demand subcutaneous morphine was available for residual pain. The following parameters were evaluated: pain severity according to the numeric scale (NS), 2 h (M1), 6 h (M2), 12 h (M3), and 24 h (M4) after the IA injection; time until the first request of analgesic; analgesic consumption, and side effects. Conclusions: The treatment group had lower NS than the control group in M1 and M2, while significant differences were not observed in the other moments. The time until the first request of analgesics was significantly higher in the treatment group, and analgesic consumption in the first 24 hours was also lower in this group. The incidence of side effects did not differ between both groups. We concluded that the postoperative IA administration of 10 mg of morphine promoted a longer period without rescue analgesics and reduced their consumption in the first 24 hours.

Justificativa y objetivos: A pesar de que la eficacia de la morfina intra-articular (IA), permanece como algo controvertido, ha quedado demostrado que las dosis mayores generan mejores resultados y consecuentemente, un menor consumo postoperatorio de analgésico, caracterizando así, el efecto dosis-dependiente en la acción periférica. Fue realizado un estudio controlado, aleatorio y doble ciego para evaluar la eficacia de 10 mg de morfina por vía intraarticular en pacientes sometidos a la artroplastia total de rodilla. Método: Se evaluaron 50 pacientes sometidos a la artroplastia total de rodilla, distribuidos aleatoriamente en dos grupos: el grupo tratamiento recibió 10 mg (1 mL) de morfina por vía intra-articular diluido en 19 mL de solución fisiológica al 0,9 por ciento (SF), mientras que el grupo control recibió una inyección intra-articular con 20 mL de SF, ambos después del cierre de la cápsula articular, al final de la operación. La morfina subcutánea bajo demanda, estuvo disponible para el dolor residual. Se evaluaron las siguientes variables: intensidad del dolor graduada en la Escala Numérica (EN) a las 2h (M1), 6h (M2), 12h (M3) y 24h (M4), después de la inyección IA; tiempo para la primera solicitación de analgésico; y consumo de analgésicos y efectos adversos. Conclusiones: El grupo tratamiento presentó menores valores en la EN que el grupo control en M1 y M2, mientras que en los otros momentos, no se registró ninguna diferencia significativa. El intervalo para la primera solicitación de analgésicos fue significantemente mayor en el grupo tratamiento y el consumo de analgésicos en las primeras 24 horas fue menor en ese grupo. No hubo diferencia entre la incidencia de efectos adversos entre los grupos. Llegamos a la conclusión, de que 10 mg de morfina redujeron el dolor del postoperatorio entre 2 y 6 horas después de aplicada la inyección IA, y se generó un periodo mayor sin analgésico de rescate reduciendo su consumo en las...

Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal / Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal / Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

Justificativa e objetivos: O procedimento de correção de pé torto congênito (PTC) cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças...

Background and objetives: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children...

Justificativa y objetivos: El procedimiento de corrección depie jorobado congénito (PJC), debuta con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección...

Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril / Efectos de la analgesia epidural y del bloqueo continuo del plexo lumbar sobre la rehabilitación funcional después de la artroplastia total de cadera / Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

JUSTIFICATIVA E OBJETIVOS: A dor após artroplastia total do quadril (ATQ) é intensa e agravada pelas mobilizações, o que demanda técnica analgésica eficaz e que permita mobilidade precoce, participação nas atividades de reabilitação e rápida recuperação funcional. O objetivo do estudo foi comparar os efeitos das técnicas de analgesia controlada pelo paciente (ACP) pelas vias peridural e perineural do plexo lombar sobre a reabilitação funcional em pacientes submetidos à ATQ. MÉTODO: Pacientes estado físico ASA I a III foram alocados aleatoriamente nos grupos Peridural e Lombar. Para a ATQ, foi realizada anestesia peridural lombar contínua com ropivacaína a 0,5 por cento (Peridural) ou bloqueio contínuo do plexo lombar com ropivacaína a 0,5 por cento (Lombar). Na sala de recuperação, iniciou-se ACP com infusão de ropivacaína a 0,2 por cento (Lombar) ou ropivacaína a 0,2 por cento + fentanil 3 µg.mL-1 (Peridural). A eficácia da analgesia nas primeiras 48 horas após a ATQ (escores de dor, consumo de morfina de resgate e de bolos da bomba de ACP) foi comparada entre os grupos. Diferentes parâmetros da reabilitação pós-operatória foram estudados. RESULTADOS: Quarenta e um pacientes foram submetidos à análise estatística. Os escores de dor em repouso foram semelhantes nos dois grupos. Apesar do controle mais efetivo da dor dinâmica no grupo Peridural e o uso de morfina ter sido maior, mais frequente e mais precoce no grupo Lombar, não houve diferença entre os grupos em nenhum dos parâmetros estudados de reabilitação. As técnicas de analgesia não influenciaram as falhas no processo de reabilitação. CONCLUSÕES: A maior efetividade da analgesia peridural não se traduziu em melhora no processo de reabilitação, nem reduziu o tempo necessário para alcançar os desfechos estudados.

BAKGROUND AND OBJECTIVES: Pain after total hip arthroplasty (THA) is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation in rehabilitation activities, and fast functional recovery. The objective of this study was to compare the effects of epidural and perineural patient-controlled analgesia (PCA) of the lumbar plexus on functional rehabilitation of patients undergoing THA. METHODS: Patients classified as physical status ASA I to III were randomly divided into two groups: Epidural and Lumbar. For THA, patients underwent continuous epidural lumbar block with 0.5 percent ropivacaine (Epidural) or continuous lumbar plexus block with 0.5 percent ropivacaine (Lumbar). In the recovery room, PCA with infusion of 0.2 percent ropivacaine (Lumbar) or 0.2 percent ropivacaine + fentanyl 3 µg.mL-1 (Epidural) was instituted. Analgesic efficacy in the first 48 hours after THA (pain scores, rescue morphine consumption, and bolus of the PCA pump) was compared between both groups. Different postoperative rehabilitation parameters were analyzed. RESULTS: Forty-one patients underwent statistical analysis. Resting pain scores were similar in both groups. Despite more effective control of dynamic pain in the Epidural group and the greater, more frequent, and earlier morphine consumption in the Lumbar group, rehabilitation parameters evaluated did not differ in both groups. Analgesia techniques did not affect rehabilitation failures. CONCLUSIONS: The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals.

JUSTIFICATIVA Y OBJETIVOS: El dolor después de la artroplastia total de la cadera (ATC) es intenso y se agrava por los movimientos, lo que demanda una técnica analgésica eficaz y que permita la movilidad precoz, la participación en las actividades de rehabilitación, y una rápida recuperación funcional. El objetivo de este estudio, fue comparar los efectos de las técnicas de analgesia controlada por el paciente (ACP), por las vías epidural y perineural del plexo lumbar sobre la rehabilitación funcional en pacientes sometidos a la ATC. MÉTODO: Pacientes en estado físico ASA I a III, que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. Para la ATC, se realizó la anestesia epidural lumbar continua con ropivacaína a 0,5 por ciento (Epidural) o bloqueo continuo del plexo lumbar con ropivacaína a 0,5 por ciento (Lumbar). En la sala de recuperación, se inició ACP con infusión de ropivacaína a 0,2 por ciento (Lumbar) o ropivacaína a 0,2 por ciento + fentanil 3 µg.mL-1 (Epidural). La eficacia de la analgesia en las primeras 48 horas después de la ATC (niveles de dolor, consumo de morfina de rescate y de bolos de la bomba de ACP), se comparó entre los grupos. Los diferentes parámetros de la rehabilitación postoperatoria también se estudiaron. RESULTADOS: Cuarenta y un pacientes se sometieron al análisis estadístico. Los niveles de dolor en reposo fueron similares en los dos grupos. A pesar de un control más efectivo del dolor dinámico en el grupo Epidural y de un uso más potente de la morfina, que se aplicó más a menudo y precozmente en el grupo Lumbar, no hubo diferencia entre los grupos en ninguno de los parámetros estudiados de rehabilitación. Las técnicas de analgesia no influyeron en las fallas en el proceso de rehabilitación. CONCLUSIONES: El más alto nivel de efectividad de la analgesia epidural, no se tradujo en una mejoría en el proceso de rehabilitación, ni tampoco redujo el tiempo necesario para alcanzar los resultados estudiados.

The Comparison of Postoperative Analgesic Effect of Morphine-Bupivacaine and Morphine-Bupivacaine-Clonidine Injected Intraarticularly after Knee Arthroscopy / 대한마취과학회지

BACKGROUND: Intraarticular opioids and local anesthetics may provide effective analgesia following knee arthroscopic surgery. However, there are conflicting results about the analgesic effects of a combination of morphine, bupivacaine and clonidine injected intraarticularly following knee arthroscopic surgery. The goal of this study was to determine whether clonidine added to an intraarticular morphine- bupivacaine combination provide an analgesic benefit. METHODS: Thirty patients scheduled for knee arthroscopic surgery under epidural anesthesia were selected and divided to two groups randomly. The patients in Group 1 received a combination of morphine 3 mg 0.25% bupivacaine 30 ml and patients in Group 2 received a combination of clonidine 3microgram/kg and morphine 3 mg in 30 ml of 0.25% bupivacaine intraarticularly following knee arthroscopic surgery. Postoperative pain was assessed using the visual analogue scale (VAS) and changes of arterial blood pressure, heart rate, requirement of additional analgesics, adverse effects and sedation scale were observed at 1, 2, 4, 8 and 24 hours after intraarticular injection. RESULTS: The VAS observed at 4, 8 and 24 hours after intraarticular injection were significantly lower in group 2 than group 1. Blood pressure and heart rate were not significantly changed between group 1 and group 2. The incidence of side effects, injection of additional analgesics and sedation were similar between the groups. There were no significant differences in hemodynamic changes, analgesic requirements, sedation scale or the increase of side effects between group 1 and group 2. CONCLUSIONS: The results suggest that the combination of intraarticular morphine 3 mg in 30 ml 0.25% bupivacaine plus clonidine provides significantly better analgesia than morphine 3 mg in 30 ml 0.25% bupivacaine alone following knee arthroscopy.

Comparing the Effects between a Continuous Epidural Infusion of an Opioid or an Opioid-Local Anesthetic Mixture and a Continuous IV Infusion of an Opioid after a Spinal Laminectomy / 대한마취과학회지

BACKGROUND: Postoperative pain after a spinal laminectomy has very harmful effects on human physiology, and many people are trying to control it more easily and safely. There are controversies in methods used for controlling postoperative pain after a spinal laminectomy. The purpose of this study was to examine an effective way to control postoperative pain after a spinal laminectomy. METHODS: Ninety patients (ASA I-II, aged 40 to 70) scheduled for a spinal laminectomy were divided into three groups. In group A, we administered fentanyl 1,000 microgram and morphine 5 mg (mixed in 0.9% normal saline) using the continuous epidural infuser; in group B, we administered fentanyl 500 microgram and morphine 5 mg and 0.25% bupivacaine (mixed in 0.9% normal saline) using the continuous epidural infuser; in group C, we administered fentanyl 1,500 microgram and morphine 10 mg (mixed in 0.9% normal saline) using the continuous IV infuser. We compared effects between the continuous epidural infusion and the continuous intravenous infusion by using the visual analogue scale and side effects. RESULTS: There was no significant difference between continuous epidural infusion groups. When the continuous epidural infusion groups and the continuous IV infusion group were compared, there were significant differences in 3 hr, 6 hr, and 12 hr VAS scores (P < 0.01). The incidence of side effects was very low, and there was no significant difference in side effects between the continuous epidural infusion and the continuous IV infusion groups. CONCLUSIONS: It was found that continuous epidural infusion methods were more effective than the continuous IV infusion method, but none of them showed satisfactory postoperative pain control in the early periods.

The Effects of Anesthetic Techniques and Postoperative Pain Control on the Response of the Stress and Immune System in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Surgical trauma may affect the host immune system. We have examined the time course of circulating interleukin-6 (IL-6) and cortisol in patients undergoing a cesarean section (c/s) to determine if the anesthetic techniques and postoperative pain control have an effect on the response of the stress and immune system. METHODS: Thirty healthy women undergoing c/s were randomly allocated to three groups. Group I (n = 10) was provided with general anesthesia, group II (n = 10) with epidural anesthesia and group III (n = 10) with epidural anesthesia plus continuous epidural analgesia for postoperative pain control. Blood samplings for IL-6 and cortisol were conducted 4 times in all patients: preoperation, 1 h, 3 h and 24 h after skin incision. RESULTS: The mean concentrations of IL-6 were significantly increased in all three groups at 3 h and 24 h after the skin incision, but there were no significant differences among the three groups. The mean concentrations of cortisol were significantly increased in three groups at 1 h and 3 h after the skin incision, but there were no significant differences among the three groups. CONCLSIONS: No significant differences among three groups were seen. Thus, We couldn't determine that anesthetic techniques and postoperative pain control had a significant effect on the response of the stress and immune system.