A prospective randomized comparative study of postoperative pain control using an epidural catheter in patients undergoing posterior lumbar interbody fusion.

PURPOSE: To assess the efficacy of continuous epidural infusion analgesia (ED) with 0.2 % Ropivacaine versus IV PCA (Fentanyl) in spinal fusion surgery patients. METHOD: A prospective randomized comparative clinical trial. Patients were randomized into one of two groups-the epidural group (ED-51 patients) and the IV PCA group (IV-43 patients). The epidural catheter tip was placed one level cephalad to the level of the PLIF in patients in the ED group. Patients were assessed by determining the pain score, cumulative opioid requirement, adverse effects, and satisfaction. RESULTS: Pain score comparisons between the ED group and the IV group, respectively, were as follows: immediate postoperative status: 2.1 ± 1.5 vs. 7.2 ± 2.1, p = 0.01; postoperative day 1: 2.3 ± 1.9 vs. 6.8 ± 2.3, p = 0.02; postoperative day 2: 1.9 ± 1.8 vs. 5.4 ± 2.1, p = 0.02; postoperative day 3: 1.5 ± 1.6 vs. 3.9 ± 1.9, p = 0.03; postoperative day 4: 3.8 ± 2.1 vs. 3.1 ± 1.9, p = 0.4. Lower levels of opioids were required in the ED group, and fewer opioid-related complications developed in the patients in this group. Complications related to the use of epidural catheters were comparable between the two groups. Patient satisfaction with postoperative pain control was higher in the ED group. CONCLUSION: In comparison with the use of IV PCA only, continuous epidural infusion of Ropivacaine resulted in lower pain scores and opioid consumption and higher patient satisfaction levels after posterior lumbar interbody fusion.

Cross Pubic Femoro-femoral Artery Bypass with Great Saphenous Vein / 대한혈관외과학회지

PURPOSE: The purpose of this study was to evaluate the great saphenous vein (GSV) as a conduit for crossover femoro-femoral bypass. Generally the conduit for crossover femoro-femoral bypass is a synthetic material because of the acceptable long-term patency and low complication rates. But, as the average life expectancy becomes extended, a better patency rate becomes more important. In this study, we compared the patency rates and hemodynamic results between crossover femoro-femoral bypass operations with GSVs and those with synthetic grafts. METHODS: From 1998 to 2008, 119 femoro-femoral bypass operations were done. Among them, 38 femoro-femoral bypass used GSV as a conduit (group I) and 79 operations used expanded polytetrafluoroethylene (group II). Two cases used arm veins and we excluded those cases. RESULTS: The 3 year primary patency rate of total cases was 75.1%, 93.7% in group I and 66.1% in group II. There were no statistical differences in hemodynamic results such as peak systolic velocity, volume flow and ankle/brachial systolic pressure index between the two groups. CONCLUSION: The 3 year primary patency rate of group I was better than that of group II. However there were no differences in hemodynamic changes. So GSV is recommended as a conduit for crossover femoro-femoral bypass especially in young patients who are eager to have longer patency rates after surgery instead of less invasive endovascular therapy.

The Morphologic Changes of Femoral Artery-graft Anastomosis with the Squatting Position

PURPOSE: There is a traditional belief that the oriental squatting position could be harmful to a femoral artery-graft anastomosis. Should patients be advised not to squat after a femoral artery bypass-graft? We studied the morphological changes during squatting to determine if there were any negative effects on the anastomosis configuration. METHOD: For a fluoroscopic marker, after the anastomosis at least five 2 mm Hemo-clips(R) (Telefix, Inc., US) with an interval of 1 mm, were left along the PTFE graft and native artery in eight patients. Five patients (10 limbs) were evaluated by fluoroscopy at 2 weeks post surgery. X-rays were taken serially for lateral views of the hip joint supine, in hip flexion (90 degrees) and in the knee to chest position, which simulated squatting. The angle of the graft-artery at each position was measured in the PACS computer screen. RESULT: The angle for each position in the 10 limbs was studied. The mean angle changed from supine to the knee-chest position and was 22.2 degrees. The larger angle between the abdominal wall and the graft was reduced in all cases, which means that the shape of the graft-artery became T-shaped. CONCLUSION: The configuration of the graft-artery after squatting became T-shaped, which was contrary to our belief that the angle would decrease between the abdominal wall and the graft. There is no evidence that this configuration would have a negative influence on the graft patency.