An up-down determination of the required seated duration after intrathecal injection of bupivacaine and fentanyl for the prevention of hypotension during Cesarean delivery
AbstractPurposeA prolonged seated time after intrathecal injection of hyperbaric bupivacaine and morphine is related to the incidence of hypotension during Cesarean delivery, but results in a high incidence of pain during peritoneal closure. We conducted this study to determine the effect of the addition of intrathecal fentanyl on the relationship between seated time and hypotension and intraoperative analgesia requirements.MethodsWomen undergoing Cesarean delivery were randomized to receive an intrathecal injection of either 11.25 or 15 mg of hyperbaric bupivacaine with morphine 150 µg and fentanyl 15 µg using a combined spinal-epidural technique. The seated duration following intrathecal injection was assigned using up-down methodology. If the preceding patient was hypo- or normotensive, the next patient sat for 15 sec more or less, respectively. A systolic blood pressure
Conclusion: For patients undergoing cesarean section, 10 or 15 μg of intrathecal fentanyl with 10 mg of bupivacaine provided adequate surgical anesthesia and analgesia with minimal side effects.
Conclusion: Though both study drugs had produced prolonged postoperative analgesia compared to placebo, pregabalin had better analgesic profile in postoperative period than gabapentin.
Conclusion: Pre-emptive analgesia with caudal epidural injection of ropivacaine is a safe and effective method of postoperative analgesia.
Authors: Erdem VM, Donmez T, Uzman S, Ferahman S, Hatipoglu E, Sunamak O Abstract Introduction: Laparoscopic appendectomy (LA) has been generally performed under general anesthesia. Laparoscopic appendectomy is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. Aim: To compare spinal/epidural anesthesia (SEA) and general anesthesia (GA) during LA with respect to perioperative and postoperative adverse events and postoperative pain. Material and methods: Fifty patients, aged 18-65, who underwent LA, were randomly allocated to two groups: the GA (n = 25) and SEA (n = 25) ...
Publication date: July–August 2018Source: Spine Deformity, Volume 6, Issue 4Author(s): Benjamin J. Pieters, John T. Anderson, Nigel Price, Lynn M. Anson, Richard M. SchwendAbstractStudy DesignRandomized controlled trial.ObjectivesThe aim of this prospective randomized clinical trial was to compare low (0.5 μg/kg/h) and high (2.5 μg/kg/h) dose naloxone infusion on the time to tolerate liquids and meals after surgery, patient-controlled analgesia (PCA) opioid requirements, nausea and pruritus ratings, and hospital length of stay.Summary of Background DataAdolescents undergoing posterior spinal fusion often receiv...
We present the first reported case of a patient with a forgotten ureteral stent. A 68-year-old woman had undergone radical hysterectomy for cervical cancer in 1997, at which time bilateral ureteral stents were placed. She was admitted to our hospital with stranguria, dysuria, and lower back pain of 10 days duration. Preoperative radiologic evaluation revealed the presence of ureteral stents, which had been in place since 1997. With the patient under general anesthesia, the bilateral stents were removed by urethral cystoscopy. No stone formation was noted. The procedure was easy and fast, and no intraoperative complications occurred.
ConclusionWe suggest that a 0.5-mL injectate volume in clinical practice may produce an adjacent-level nerve block in addition to the intended injection level, thus decreasing the specificity of a targeted lumbar medial branch block. A 0.25-mL quantity of injectate reliably contacted the lumbar medial branches without extensive extravasation. Presumably, this means that 0.25 mL total volume for a lumbar medial branch block may provide greater specificity for RFA planning.Level of EvidenceNA
Publication date: January–March 2018Source: Journal of Clinical Orthopaedics and Trauma, Volume 9, Issue 1Author(s): Kimberly L Stevenson, Alexander L Neuwirth, Neil ShethAbstractAs the rate of total joint arthroplasty increases with the aging population of the United States, new focus on decreasing opioid use through the development of multimodal pain regimens (MPRs) is becoming an important area of research. MPRs use different agents and modes of delivery in order to synergistically address pain at many levels of the pain pathway. MPRs include a combination of acetaminophen, non-steroidal anti-inflammatory drugs (N...
ConclusionIn patients with chronic low back pain consistent with a symptomatic LSTV type II or IV in the Castellvi classification, a local injection of lidocaine with or without cortivazol may provide sustained improvements in pain and function. The underlying mechanism is unclear.
This study will provide a basis for evaluating future changes in practice.