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OBJETIVOS:Comparar os efeitos sobre a PIO após o bloqueio peribulbar com lidocaína e bupivacaína em pacientessubmetidos à cirurgia de facectomia com implante de lente intraocular (LIO), bem como avaliar indiretamente e comparar a distribuição dos anestésicos na órbita com a medida da exoftalmometria antes e após a anestesia peribulbar. A bupivacaína e a lidocaína são anestésicos locais que rotineiramente têm sido utilizados para realização de bloqueio peribulbar. Sabe-se que a pressão intraocular (PIO) é um fator importante no pré-operatório imediato da cirurgia de catarata para evitar possíveis complicações como perda vítrea e hérnia de íris. MÉTODOS: Cinquenta pacientes de ambos os sexos, com idade entre 48 e 93 anos, com avaliação pré-anestésica ASA I e II, foram randomizados após a conclusão da pesquisa em 2 grupos: Grupo 1: os que receberam lidocaína e Grupo 2: os que receberam bupivacaína. A medida da PIO foi realizada e analisada em 4 momentos: Antes da anestesia; 1 minuto após o bloqueio; 5 minutos após o bloqueio; 7 minutos após o bloqueio. Também foi avaliado a exoftalmometria antes e imediatamente após o bloqueio com exoftalmômetro de Luedde. RESULTADOS: Houve um aumento na medida da PIO com o bloqueio anestésico nos dois grupos comparados, porém não houve diferença estatisticamente significante no aumento da PIO quando comparada as duas drogas analisadas. Quando comparamos a exoftalmometria, identificamos que não houve diferença estatisticamente significante no aumento da proptose em relação aos dois grupos, isto é, os dois anestésicos quando comparados distribuem-se da mesma forma na cavidade orbitária. CONCLUSÃO: Não houve diferença na variação do aumento da PIO e da na variação da exoftalmometria entre os dois anestésicos comparados.
PURPOSE: To compare the effects of IOP after peribulbar anaesthesia with lidocain and bupivacain for cataract surgerywith intraocular lens implantation and evaluate exoftalmometer results after the same procedure. Bupivacain and lidocain are local drugs used for peribulbar anaesthesia. It is known that intraocular pressure (IOP) is an important factor for cataract surgery to avoid complications like vitreous loss and iris hernia. METHODS: Fifty male and female patients, between 48 and 93 years old, with ASA I and II evaluation before anaesthesia were recruted to participate for this study. We had 2 groups for the study. Group 1: lidocain patients and group 2: bupivacain patients. Intraocular pressure was measured in 4 different periods: before peribulbar anaesthesia, 1 minute, 5 minutes and 7 minutes after. We also performed exoftalmometer evaluation before and right after peribulbar anaesthesia with Luedde exoftalmometer. RESULTS: There was higher IOP after peribulbar anaesthesia, but not significant when compared between both drugs. The exoftalmometer evaluation showed that both drugs are equal distributed in orbit and they both cause proptosis of the ocular globe. CONCLUSION: There was no difference comparing higher intraocular pressure or exoftalmometer evaluation between both drugs.
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BACKGROUND: Pain management has traditionally been provided by opioid analgesics. However, the reluctance of some health personnel to prescribe or administer opioids because of the fear of side effects has hindered their use. Local anaesthetic wound infiltration has been shown to improve postoperative pain management. AIMS AND OBJECTIVES: To determine the efficacy of combined subfascial and subcutaneous infiltration of bupivacaine in providing an opioid- sparing effect following abdominal surgery. DESIGN OF THE STUDY: It was a prospective, randomized, double blind, placebo-controlled study. SETTING: The study was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. PATIENTS AND METHODS: The study group received subcutaneous and subfascial infiltration with 40ml of 0.25% bupivacaine while the control group received 40ml of 0.9% saline administered by the surgeon after the closure of the peritoneum. Postoperative analgesia was provided with intramuscular morphine 0.1mg/kg 4hourly on demand and the time to first analgesic request was noted. Intravenous paracetamol was used as rescue analgesia. Postoperative pain was assessed using the verbal rating scale (VRS) at 6, 12 and 24 hours postoperatively at rest and during coughing. RESULTS: The mean time to first analgesic request was significantly prolonged (p <0.05) in the study group (174 ± 117.6 min) than in the control group (102 ± 84 min). The patients in the control group received more morphine which was not statistically significant (p > 0.05). Request for rescue analgesia and the patients' impression of the analgesia were not significant (Fishers exact test two tailed p-value = 0.7164 and 0.4506 respectively). CONCLUSION: Bupicacaine wound infiltration improved pain scores at rest within the first 6 hours and pain scores on coughing within the first 24 hours postoperatively. Although the technique increases the options available for postoperative pain relief after lower abdominal surgery, it cannot be used alone in this type of surgery.
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Introducción: La anestesia espinal es la técnica más utilizada en la cirugía de la fractura de cadera. Se ha intentado disminuir las dosis de anestésico local al añadir opioides, sin que se afecte su calidad. Objetivo: Analizar el comportamiento de la tensión arterial media, así como la calidad de la anestesia al emplear bajas dosis de bupivacaína con fentanyl subaracnoidea en el anciano operado de fractura de cadera de urgencia. Metodología: Se diseñó un estudio prospectivo aleatorizado y doble ciego en 430 pacientes con fractura intertrocantèrica de cadera, distribuidos en dos grupos. En el grupo F se suministró fentanilo 50 µg y bupivacaína 5 mg, en el grupo B 10 mg de bupivacaína. Después de la raquianestesia fueron analizadas las variables tensión arterial media, necesidad de vasoconstrictor, tiempo de latencia para bloqueo motor y sensitivo, así como la calidad del bloqueo de los mismos y la presencia de efectos adversos Resultados: Los grupos fueron homogéneos. El grupo F presentó mayor estabilidad de la tensión arterial media. El nivel de bloqueo fue suficiente en todos los casos para realizar la intervención aunque la intensidad del bloqueo motor fue menor en los pacientes del grupo F (p< 0,01). En el grupo F el efecto secundario mas frecuente fue el prurito (p< 0,01) y en el grupo B la hipotensión arterial (p< 0,01). Conclusión: La asociación de fentanyl al anestésico local en la anestesia subaracnoidea en el paciente anciano es una técnica efectiva que permite mantener una mayor estabilidad hemodinámica, con una reducción de la dosis de bupivacaína.
Introduction: Spinal anesthesia is the more used technique used in the surgery of hip fracture. We tried to decrease the local anesthesia dose adding opiates without affection of its quality. Objective: to analyze behavior of mean arterial tension, as well as of anesthesia quality using low doses of Bupivacain plus Fentanyl by subarachnoid route in the elder operated on from a emergence hip fracture. Methodologies: We designed a double-blind, randomized and prospective study in 430 patients presenting with hip intertrochanter fracture divided into two groups. In the F group we gave Fentanyl (50µg and Bupivacain (5 mg) and in the B Bupivacain (10 mg). After rachial-therapy we analyzed the following variables: mean arterial tension, need of vasoconstrictor, latency time for a motor and sensitive blockade, as well as its quality of both drugs, and the presence of adverse effects. Results: Both groups were homogenous. Group F had a greater stability of mean arterial tension. Blockade level was enough in all cases to perform the intervention although motor blockade intensity was minor in all patients of group F (p < 0, 01), in this same group, secondary the effect was more frequent was the pruritus (p < 0,01), and in group B, arterial hypotension one (p <0,01). Conclusion: Association of Fentanyl-local anesthetic agent in subarachnoid anesthesia in elder is an effective technique allows maintaining a greater hemodynamic stability, with a reduction of Bupivacain dose.
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Objective To investigate effect of lipid emulsion on cardiac arrest induced by bupivacain intoxication.Methods Forty SD rats were randomly devided into 2 groups.Group A applied epinephrine (n=20);Group L applied lipid emulsion combinding epinephring(n=20).The rats were administered Lupivacaine 20 mg/kg.Cardiopulmonary resuscitation(CPR) was started. Epinephrine 10 μg/kg were repeated three times followed by epinephrine 10 μg/kg every 5 minutes.Normal saline 5 ml/kg and 1 ml·kg-1·min-1 were administered in group A.20% Lipid emulsion 5 ml/kg and 0.25 ml·kg-1·min-1 were administered in group L.Heart rate,blood pressure, temperature were monitored.Blood gas analysiswere checked at 5 min,30 min after restoration of spontaneous circulation(ROSC).To record the number of successful CPR,time of ROSC and epinephrine dose.Results 11 rats(55%) and 16 rats(80%) were successful resuscitated.The success rate was higher in group L than in group A.Epinephrine dose was higher in group A than in group L.There was no difference in heart rate between the two groups.Systolic blood pressure and PaO2 was higher in group L than in group A(P<0.05).Conclusion There was better effect in lipid emulsion combined epinephrine than soly epinephrine when applied in cardiac arrest induced by bupivacaine intoxication.
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Background: Laparoscopic surgery is as very safe as traditional open surgery. A laparoscopic cholecystectomy is a surgical procedure during which the doctor removes your gallbladde. Objectives: This study was to assess the effect of local and intraperitoneal bupivacain infiltration on pain relief after laparoscopic cholecystectomy and the side effects of this technique. Subjects and method: In study group (n = 37), 25 mg bupivacain 0.25 % and 75 mg were infiltrated at Trocat incisions and at intraperitoneal surgery site, respectively. In placebo group (n = 44): no infiltration was used. VAS was measured controlling patient's pain during at rest, following inspiratory effort and movement; IV perfalgan requirement and the side effects of the technique were observed. Results: VAS at rest, following inspiratory effort and movement as well as perfalgan requirement during postoperative 6 hours were lower in study group (p < 0.05). \r\n", u'A significant decrease of heart rate after 10 - 30 minute of intraperitoneal infiltration of bupivacain was noted. Conclusions: Local and intraperitoneal bupivacain infiltrations had an effectiveness on pain relief during 6 hours after laparoscopic cholecystectomy. Moderate bradycardia was a main side effect of this technique. \r\n', u' \r\n', u'
