Spinal analgesia for the postoperative period in renal donors.

BACKGROUND: To provide postoperative analgesia by spinal anesthesia, we compared the quality of analgesia and side effects of two doses of morphine added to ropivacaine in kidney donors. MATERIALS AND METHODS: Thirty renal donors underwent nephrectomy under standard general anesthesia. After the operation, the patients were randomly allocated into two groups of intrathecal doses for spinal anesthesia: the 0.5 group (n = 15) received a total volume of 4 mL including 0.5 mg morphine, 10 mg ropivacaine, and 0.9% NaCl, and the 0.3 group (n = 15), a total volume of 4 mL including 0.3 mg morphine, 10 mg ropivacaine, and 0.9% NaCl. After extubation, an intravenous (IV) morphine protocol was initiated by a patient-controlled analgesia pump to provide sufficient spinal analgesia. RESULTS: In the 0.3 group, the IV morphine consumption was significantly higher, namely, 14.60 +/- 7.57 times versus 4.60 +/- 10.14 times for the 0.5 group (P = .005). The total amount of morphine was 7.80 +/- 5.40 mg in the 0.5 group and 13.53 +/- 5.30 mg in the 0.3 group (P < .05). Postoperative side effects of nausea and vomiting were higher among the 0.3 group (P < .05). CONCLUSIONS: In the 0.5 group, the quality of analgesia was better than in the 0.3 group. The need for IV morphine was less in the 0.5 group. Also, side effects like nausea and vomiting were less, so better analgesia in the postoperative period was obtained with the 0.5 mg morphine solution.

Intrathecal ropivacaine versus ropivacaine plus fentanyl for out-patient arthroscopic knee surgery.

We evaluated the effects of low-dose intrathecal ropivacaine with or without fentanyl for arthroscopic knee surgery. Fifty patients were randomized in equal groups to receive an intrathecal solution (3 ml) containing either 10 mg isobaric ropivacaine or 8 mg isobaric ropivacaine plus 25 pg fentanyl. Complete motor blockade occurred in 22 patients (88%) in both groups. The time taken to reach sensory blockade to T10 and total motor blockade was shorter in the ropivacaine-treated group, but differences were not statistically significant. The duration of sensory and motor blockade was shorter in the ropivacaine plus fentanyl-treated group. The cephalad spread of sensory blockade was higher with ropivacaine than with ropivacaine plus fentanyl. We conclude that although 25 microg fentanyl added to 8 mg ropivacaine provided shorter motor and sensory blockade durations than 10 mg ropivacaine alone, small doses of ropivacaine plus fentanyl can be used safely for arthroscopic knee surgery.

Effects of the temporary clipping in aneurysm surgery on the remnant.

The residual aneurysm rate is reported between 3,8% and 21% in the cases followed after intracranial aneurysm surgery. In the formation of the residual aneurysm, the risk factors include such structural characteristics as the size and lobulation of the aneurysm, posterior circulation, para-ophthalmic localisation and intra-operative rupture. The rates and causes of postoperative residual aneurysms were analyzed in 186 intracranial aneurysm of 160 patients, including the possible effects of temporary clipping on the residual rates. The entire series demonstrated a residual rate of 7%. It was found higher in the large lobulating aneurysms and intra-operative rupture. The residual rate considerably decreased to 4,2% in the aneurysms with temporary clipping. The determination of residual aneurysms, identification of any risk factors and elimination of recoverable factors would allow improvement of surgical results in the treatment of the intracranial aneurysms in the future. Moreover we believe that these will be useful in development of the indications for alternative treatment methods.