Does the addition of ketorolac and dexamethasone to lidocaine intravenous regional anesthesia improve postoperative analgesia and tourniquet tolerance for ambulatory hand surgery?

BACKGROUND: The inability to provide effective postoperative analgesia is one of the major disadvantages of intravenous regional anesthesia (IVRA). We designed a prospective, randomized, double blind study to evaluate the analgesic effectiveness of adding both ketorolac and dexamethasone to lidocaine for IVRA. METHODS: The study involved 45 patients undergoing ambulatory hand surgery. They were randomly allocated into three groups: Group L, Group LK and Group LDK. Group L received 3 mg x kg-1 lidocaine; Group LK received 3 mg x kg-1 lidocaine + 30 mg ketorolac; and Group LDK received 3 mg x kg-1 lidocaine for IVRA + 8 mg dexamethasone + 30 mg ketorolac for IVRA using a 40 mL solution. Sensory and motor block onset and recovery times were recorded. Tourniquet pain and pain at the operative site were assessed by a visual analog scale. In the first 24 h after surgery, opioid requirements and total analgesic consumption, including side effects, were noted. RESULTS: Sensory and motor block onset and recovery times were similar in all groups. Patients in Groups LK and LDK required less alfentanyl for control of intraoperative and early postoperative pain. Further, patients in Groups LK and LDK reported significantly lower pain scores compared to those in Group L (P<0.001). Patients in Groups LK and LDK required fewer postoperative ketorolac tablets (2.2+/-1.6 and 1.3+/-0.6 tablets, respectively) in the first 24 h after surgery and had significantly longer periods during which they required no analgesics (524 min and 566 min, respectively) compared to those in Group L (3.8+/-1.3 tablets; 122 min, P<0.001). CONCLUSION: IVRA with lidocaine and with the inclusion of ketorolac and dexamethasone provides effective perioperative analgesia for patients undergoing ambulatory hand surgery, when compared to the use of lidocaine alone or lidocaine with ketorolac IVRA.

Can a patient be successfully prepared for pheochromocytoma surgery in three days? A case report.

The case of a patient who insisted on urgent surgical removal of a pheochromocytoma is presented. Rapid preparation started with continuous infusion of urapidil 3 days before surgery. On the evening before the operation, an additional infusion of magnesium sulphate was started. The target of preoperative optimization was to maintain blood pressure <140/90 mm Hg and heart rate <100 beats min(-l). Anesthesia was induced with fentanyl, propofol and rocuronium and maintained with sevoflurane in 100% oxygen and continuous infusion of fentanyl. Hypertensive events were treated by continuous infusions of urapidil and magnesium sulphate. Just before tumor resection, additional boluses of urapidil and MgSO4 were administered; both fentanyl infusion and end tidal concentration of sevoflurane were increased. Blood pressure was well maintained through the anesthesia; no transient periods of hypotension after tumor removal were observed. The patient's peroperative course was uneventful. He was discharged home without antihypertensive medication on the 5th postoperative day. This case demonstrates that with urapidil and magnesium sulphate administration rapid preparation for pheochromocytoma resection can be successfully achieved within 3 days.

Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Venous thromboembolism is a relevant social and health care problem because of its high incidence among patients who undergo surgery (20-30% after general surgical operations and 50-75% after orthopedic procedures), its pulmonary embolism-related mortality rate, and its long-term sequelae (postthrombotic syndrome and ulceration), which may be disabling. This study aimed to determine the coagulation status and the presence of postoperative deep vein thrombosis (DVT) in patients undergoing laparoscopic (LC) and open cholecystectomy (OC). METHODS: Prospectively, 114 patients were randomized into two groups. group 1 (58 patients undergoing LC) and group 2 (56 patients who are undergoing OC). The coagulation parameters (prothrombin time [PT], partial thromboplastin time [PTT], D-dimer, prothrombin F1 + 2, antithrombin III, and factor VII) were monitored preoperatively and during the operation, then 24 and 72 h after the operation. The patients in both groups underwent color duplex scan examination preoperatively, then 3 and 7 days after surgery to establish the presence of DVT. None of the patients in either group received thrombosis prophylaxis. RESULTS: In the LC group, postoperative DVT developed in four patients (6.9%; in the calf veins of 3 patients and in the popliteal vein of 1 patient). In the OC group, nine patients (16.07%) had postoperative DVT (in the calf veins of 7 patients and in the popliteal and femoral veins of 2 patients). The plasma levels of monitored parameters in the patients of both groups were altered, but the difference between the groups was not statistically significant. For the patients in both groups who experienced DVT, only the decrease of factor VII had statistical significance (p < 0.05). CONCLUSIONS: The incidence of postoperative DVT among the patients who underwent OC was higher than among the patients who underwent LC (p < 0.05). The decrease in factor VII among the patients who underwent surgery could be a potentially useful parameter indicating the patients at high risk for developing DVT.

Primary omental liposarcoma presenting as an incarcerated inguinal hernia.

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours' duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldice's method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.