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Furumoto, Kayo, Kumi Ogita, Tomomi Kamisaka, Asami Kawasumi, Koushi Takata, Noritaka Maeta, Takamasa Itoi, Masakatsu Nohara, Kaori Saeki, and Teppei Kanda. "Effects of Multimodal Analgesic Protocol, with Buprenorphine and Meloxicam, on Mice Well-Being: A Dose Finding Study." Animals 11, no. 12 (November 30, 2021): 3420. http://dx.doi.org/10.3390/ani11123420.
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The anesthetic or analgesic agent of choice, route and frequency of anesthetic or analgesic administration, and stressors induce distress during the perioperative period. We evaluated a multimodal analgesic protocol using buprenorphine and meloxicam on the well-being of mice. Twenty-four Slc:ICR male mice were divided into control, anesthesia + analgesia, and surgery + anesthesia + analgesia groups. Tap water (orally: PO) and water for injection (subcutaneous: SC) were administered to the control group. Buprenorphine was administered twice (SC, 0.1 mg/kg/8 h) and meloxicam was administered thrice (PO, 5 mg/kg/24 h) to the anesthesia + analgesia and surgery + anesthesia + analgesia groups. The mice were subjected to laparotomy and assessed for several parameters. Even in absence of surgical pain, the anesthesia + analgesia group presented the same negative effects as the surgery + anesthesia + analgesia group. This multimodal analgesic protocol for mice was expected to have an analgesic effect on pain associated with laparotomy but was not sufficient to prevent food intake and weight decrease. This does not negate the need to administer analgesics, but suggests the need to focus on and care not only about the approach to relieve pain associated with surgery, but also other types of distresses to minimize negative side effects that may interfere with postoperative recovery in mice.
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Tkachenko, R. O. "Modern anesthesia in obstetrics as a component of the concept of safe anesthesia." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 280–82. http://dx.doi.org/10.32902/2663-0338-2020-3.2-280-282.
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Background. Anesthesia should be selected individually for each labor. Systemic analgesia of labor includes suggestive analgesia, narcotic analgesics, local infiltration and regional blockade, inhalation analgesia. It should be noted that there is no analgesic, sedative or local anesthetic that does not penetrate the placenta, affecting the fetus in any way.
Objective. To describe modern anesthesia in obstetrics.
Materials and methods. Analysis of literature sources on this issue.
Results and discussion. Three groups of antispasmodics are used for analgesia: neurotropic (atropine, scopolamine), myotropic (papaverine, drotaverine) and neuromyotropic (baralgin). The main non-steroidal anti-inflammatory drugs used for this purpose include metamizole sodium, ketorolac tromethamine, diclofenac sodium. Inhalation autoanalgesia with nitrous oxide (N2O) is effective only in 30-50 % of women. When the concentration of N2O exceeds 50 %, the sedative effect increases and oxygenation decreases, which leads to the loss of consciousness and protective laryngeal reflexes. Such analgesia is indicated for low-risk patients who have refused from regional anesthesia. Epidural anesthesia (EDA) is the gold standard of labor anesthesia. The advantages of EDA include the option to change the degree of analgesia, the ability to continue pain relief until the end of labor and the minimal impact on the condition of both child and mother. Before manipulation, be sure to determine the platelet count and heart rate of the fetus. It is recommended to start EDA in the latent stage of labor. In patients with uterine scarring, early EDA is a mandatory component of medical care. The woman’s wish is the main indication for EDA. Indications for early catheterization of the epidural space include the presence of twins, preeclampsia, obesity, respiratory tract with special features. Headache is the most common complication of EDA. The use of pencil-point spinal needles minimizes the frequency of this complication. Adequate analgesia for uncomplicated labor should be performed with minimal concentrations of anesthetics with the least possible motor block. Local anesthetics (lidocaine, bupivacaine (Longocaine, “Yuria-Pharm”), ropivacaine) are used for EDA). Combined spinal-epidural anesthesia provides a rapid effect and long-term analgesia. For this purpose, 0.25 % Longocaine heavy (“Yuria-Pharm”) 2 mg and fentanyl 20 μg are administered intrathecally, followed by 0.225 % Longocaine 10 mg and fentanyl 20 μg epidurally. The technique of epidural dural puncture is a modification of combined spinal-epidural anesthesia. This technique improves the caudal spread of analgesia compared to the epidural technique without the side effects seen with spinal-epidural anesthesia. The ideal local anesthetic should be safe for both mother and fetus, provide sufficient analgesia with minimal motor block, and not affect labor process. A single spinal injection of opioids may be effective, but it should be limited in time. The use of systemic opioids during labor increases the need for resuscitation of newborns and worsens the condition of their acid-base balance compared to basic regional anesthesia. Catheter techniques can be used in case of the increased labor duration. Nalbuphine (“Yuria-Pharm”), which eliminates the side effects of regional anesthesia, can also be successfully used. Analgesic effect of paracetamol (Infulgan, “Yuria-Pharm”) in case of intravenous administration exceeds the analgetic effect of tramadol, and the effect on the newborn condition according to the Apgar scale does not differ (Meenakshi et al., 2015). Paracetamol (Infulgan) is moderately effective for perineal pain on the first day after delivery. The possibility of use during lactation is an another advantage of paracetamol.
Conclusions. 1. Pain during labor is an extremely stressful factor, so women should have access to quality analgesia and anesthesia. 2. There is no analgesic, sedative or local anesthetic that does not penetrate the placenta, affecting the fetus. 3. EDA is the gold standard of labor anesthesia. 4. Combined spinal-epidural anesthesia provides rapid effect and long-term analgesia. 5. The use of systemic opioids during labor increases the need for resuscitation of newborns and worsens the condition of their acid-base balance. 6. Nalbuphine and Infulgan have been used successfully for labor pain relief.
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Sekulovski, M., B. Simonska, G. Mutafov, V. Alexandrov, and L. Spassov. "Bilateral ultrasound-guided abdominal peripheral block in tap plane, tap - block." Trakia Journal of Sciences 18, no. 4 (2020): 344–49. http://dx.doi.org/10.15547/tjs.2020.04.009.
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INTRODUCTION: Bilateral ultrasound-guided peripheral block (TAP - block) in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle – TAP plane, is a regional anesthesia technique by infiltration of a local anesthetic, provides analgesia for operations involving the anterior abdominal wall. The analgesic effectiveness of the block decreases the consumption of opioid analgesics and non-steroidal anti-inflammatory drugs. AIM: In this study, we evaluated the intraoperative analgesic efficacy of bilateral TAP - block and the consumption of opioid analgesics in patients undergoing bilateral laparoscopic inguinal hernia repair. METHODS: The study was conducted with 35 patients, who were randomized into two groups. In the control group (group I), there are patients who received general anesthesia (GA), and experimental group (group II), were patients who have received general anesthesia and a bilateral tap block (GA + TAP). RESULTS: Patients with TAP-block (group II) have significantly lower fentanyl consumption compared to group I. CONCLUSION: Multimodal approach for the simultaneous administration of general anesthesia with a TAP block provides effective intraoperative analgesia and significantly reduces the perioperative consumption of opioid analgesics.
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Pulkina, O. N., V. P. Ivanov, V. I. Gurskaya, and E. V. Parshin. "Infiltrative analgesia of the skin flap in children with craniosynostosis after reconstructive surgery on skull bones." Messenger of ANESTHESIOLOGY AND RESUSCITATION 16, no. 6 (January 27, 2020): 37–45. http://dx.doi.org/10.21292/2078-5658-2019-16-6-37-45.
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The objective of the study is to evaluate the effectiveness of analgesia by infiltration of the skin flap with local anesthetic in children with craniosynostosis after reconstructive surgery.Materials and subjects. 50 children with craniosynostosis, who underwent reconstructive surgery on skull bones, were divided into two groups based on the method of postoperative anesthesia: in Group 1(experimental), the infiltration of the skin flap was used within multimodal anesthesia, while in Group 2, it was standard parenteral use of analgesic drugs. In the postoperative period, pain severity was assessed by FLACC scales, the amount of opioid and non-opioid analgesics consumed was assessed by the formalized Analgesiс Assessment Scale (FSA), and non-invasive hemodynamic monitoring (BP, HR) was performed.Results. The statistical analysis of the results revealed significant differences between groups in the assessment results of FSA and FLACC scales. In Group 1, the level of postoperative pain was significantly lower compared to Group 2. The amount of opioid and non-opioid analgesics consumed was also significantly lower in Group 1.Conclusion. The use of the infiltration of the skin flap as part of multimodal analgesia in children with craniosynostosis, after reconstructive surgery on skull bones significantly reduces the intensity of pain and the amount of opioid analgesics consumed in the postoperative period.
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Waechter, Fábio Luiz, José Artur Sampaio, Rinaldo Danesi Pinto, Mário Reis ÁLvares-Da-Silva, and Luiz Pereira-Lima. "A Comparison between Topical and Infiltrative Bupivacaine and Intravenous Meperidine for Postoperative Analgesia after Inguinal Herniorrhaphy." American Surgeon 67, no. 5 (May 2001): 447–50. http://dx.doi.org/10.1177/000313480106700513.
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The purpose of the present study is to compare postoperative analgesia offered by the simple instillation of local anesthetic on the surgical wound, its infiltration with the same local anesthetic, and the use of an intravenous opioid. Sixty patients were divided into the three analgesia groups to be studied: instillation of local anesthetic (Group I), injection of local anesthetic (Group II), and intravenous opioid (Group III). The pain was quantified using the visual analogue scale. It was observed that there was better analgesia in Groups I and II during the first 6 hours postoperatively as compared with Group III ( P < 0.0001). At the end of the 12 hours the three modes of analgesia proved comparable. However, after 24 hours there was better analgesic development in Group I, whereas Group II had greater postoperative morbidity. We conclude that the instillation of local anesthesia provides analgesia during the immediate postoperative period comparable to local infiltration using the same anesthetic. Both regional analgesia methods are more effective analgesics during the first 6 hours than are intravenous opioids. Furthermore the simple instillation of local anesthetic allows better analgesic evolution of the surgical wound after the first 24 hours considering the lower rate of resulting complications.
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Lisnyi, І. І. "Perioperative anesthesia." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 178–79. http://dx.doi.org/10.32902/2663-0338-2020-3.2-178-179.
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Background. Ensuring adequate analgesia is a prerequisite for rapid recovery after surgery. Improving the management of acute pain is important to ensure the safe and effective analgesia needed for early mobilization and for avoidance of organ dysfunction due to inadequate analgesia. For this purpose, multimodal analgesia (MMA) is used. It includes opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAID), paracetamol or metamizole, local anesthetics and ancillary drugs.
Objective. To describe modern views on perioperative analgesia.
Materials and methods. Analysis of literature data on this issue.
Results and discussion. MMA involves an opioid-preserving approach (reducing the dose of opioids without reducing the quality of analgesia), procedure and patient specificity. The postoperative recovery improvement program includes several items, three of which have been associated with a reduction in treatment duration, namely, multimodal prevention of postoperative nausea and vomiting, perioperative NSAID use, and post-operative opioid protocol. The combined use of NSAID and paracetamol provides a better result than the use of each of these drugs alone. At the correct dose, paracetamol (Infulgan, “Yuria-Pharm”) is an effective non-opioid analgesic for the treatment of acute pain with minimal side effects for a long time. Pre- and intraoperative administration of paracetamol is recommended in a number of guidelines. Intravenous administration of local anesthetics is an another important component of MMA. The 2016 Cochrane review showed that long-term intravenous perioperative infusion of lidocaine significantly reduced the postoperative need for opioids. However, the meta-analysis of 10 randomized controlled trials found that perioperative intravenous lidocaine did not differ from placebo in post-operative pain assessed with the help of a visual analog scale and in opioid requirements (Rollins K.E., 2020). Similar results have been obtained in other studies in recent years. Inclusion of nefopam in MMA can reduce the dose of opioids. The use of nefopam, paracetamol and deksketoprofen makes it possible to dramatically reduce the use of morphine. Neither pain nor postoperative recovery can be adequately controlled with a single treatment due to the multifactorial nature of the problem. It is recommended to use MMA, but there are no recommendations for optimal combinations of analgesics for specific procedures. Administration of paracetamol and NSAID in combination with the use of regional techniques is a golden standard of MMA.
Conclusions. 1. After the surgery, the patient should be adequately anesthetized. 2. To achieve optimal, preferably non-opioid, analgesia, it is recommended to use MMA. 3. NSAID, paracetamol, nefopam and regional techniques are the important components of MMA.
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Ma, Xiaofan, Jiali Peng, Yelin Chen, Zeyi Wang, Qiang Zhou, Jia Yan, and Hong Jiang. "Esketamine Anesthetizes Mice With a Similar Potency to Racemic Ketamine." Dose-Response 21, no. 1 (January 2023): 155932582311575. http://dx.doi.org/10.1177/15593258231157563.
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Esketamine, the right-handed optical isomer of racemic ketamine, has recently become widely used for anesthesia and analgesia as a replacement for racemic ketamine. However, there are limited studies comparing the anesthetic and analgesic effects of esketamine and racemic ketamine in mice. This research was conducted to analyze the dose-dependent anesthetic and analgesic efficacy of esketamine in mice and to compare its potency with that of the racemate. We tested the anesthetic effects of different doses of esketamine and compared its potency with that of the racemate using righting reflex tests. Then, the acetic acid-induced pain model and formalin-induced pain model were used to investigate the analgesic effect. Compared with racemic ketamine, an equivalent dose of esketamine at 100 mg/kg was required to induce stable anesthesia. In contrast, 5 mg/kg esketamine was sufficient to provide analgesic effects similar to those of 10 mg/kg ketamine. Together, esketamine had a similar potency to racemic ketamine for anesthesia and a stronger potency for analgesia in mice.
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Hu, Chaojun, Shan Zhang, Qian Chen, and Rong Wang. "Effects of Different Anesthetic and Analgesic Methods on Cellular Immune Function and Stress Hormone Levels in Patients Undergoing Esophageal Cancer Surgery." Journal of Healthcare Engineering 2022 (March 12, 2022): 1–9. http://dx.doi.org/10.1155/2022/4752609.
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The change of perioperative immune function in patients with esophageal cancer is mainly caused by the joint action of surgical trauma and anesthesia. In our study, we aimed to investigate the effects of different anesthetic methods on the changes of T lymphocyte subsets and cytokines in peripheral blood of patients with esophageal cancer surgery. 50 patients with esophageal cancer were divided into the study group and the control group. Among them, the patients in the control group chose intravenous anesthesia and received self-controlled intravenous analgesia after surgery. Patients in the study group chose thoracic epidural anesthesia combined with general anesthesia, undergoing self-controlled epidural analgesia after surgery; serum interleukin-2 (IL-2) and soluble interleukin-2 receptor (sIL-2R) were measured by ELISA. Serum stress hormones GH and sIL-8 were measured by radioimmunoassay. Both groups of patients achieved significant postoperative analgesia, but the VAS score in the study group at the T2–T4 time point was lower than that in the control group. The serum GH concentration in the study group increased at T1 and reached its highest peak at T2, then decreased. The serum IL-8 concentration of the two groups showed a downward trend from T1 to T4. Thoracic epidural anesthesia combined with general anesthesia for postoperative epidural analgesia can relieve the degree of cellular immunosuppression during and after surgery. Moreover, the thoracic epidural block combined with general anesthesia for esophageal cancer surgery and epidural analgesia after surgery for patients are anesthetic and analgesic methods with clinically significant effects. Our research results have a positive effect on the promotion of postoperative rehabilitation in patients with malignant cell tumors.
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Fayziev, Otabek Ya, T. S. Agzamhodjaev, A. S. Yusupov, and I. A. Mamatkulov. "IMPROVEMENT OF COMBINED MULTIMODAL ANESTHESIA FOR ABDOMINAL SURGICAL INTERVENTIONS IN CHILDREN." Russian Pediatric Journal 21, no. 6 (April 30, 2019): 362–65. http://dx.doi.org/10.18821/1560-9561-2018-21-6-362-365.
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The aim of the study was to enhance the efficiency and safety of the combined methods of anesthesia using propofol and epidural anesthesia for the abdominal surgery in children by assessing the hemodynamic regulation of the heart rhythm and the clinical course of anesthesia. Materials and methods. We studied children aged of 1 to 14 years operated for diseases and malformations of the abdominal cavity. To ensure the anesthetic protection in 57% of affected children there was used combined epidural anesthesia by bupivacaine combined with propofol and fentanyl in cases from the 1 (main) group and in 43% of affected children there was applied the combined anesthesia by fentanyl and droperidol with lidocaine epidural anesthesia - 2 (control) groups. Results The results showed the relative stability of the patients providing adequate pain relief after the surgery in children. Use of a combination of drugs: early fentanyl analgesic effect develops, whereas propofol implements its action later, and provides a prolongation of analgesia. Propofol, fentanyl with epidural analgesia bupivacaine for analgesic effect appeared to be several times higher than methods of neuroleptanalgesia.
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Stojanović, Simona, Nikola Burić, Milos Tijanić, Kosta Todorović, Kristina Burić, Nina Burić, Marija Jovanović, and Vukadin Bajagić. "The Assessment of Prolonged Inferior Alveolar Nerve Blockade for Postoperative Analgesia in Mandibular Third Molar Surgery by a Perineural Addition of Dexamethasone to 0.5% Ropivacaine: A Randomized Comparison Study." International Journal of Environmental Research and Public Health 19, no. 3 (January 25, 2022): 1324. http://dx.doi.org/10.3390/ijerph19031324.
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Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.
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Neimark, Mihail I., Roman V. Kiselev, and Evgeniy V. Goncharov. "Opiode-saving anesthesia and analgesia as a component of ERAS in endoscopic adrenalectomy in obese patients." Regional Anesthesia and Acute Pain Management 15, no. 4 (June 19, 2022): 277–86. http://dx.doi.org/10.17816/1993-6508-2021-15-4-277-286.
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BACKGROUND: Anesthetic management during interventions on the adrenal glands is quite complex. Difficulties in conducting anesthesia are often determined by concomitant obesity, which is associated with an increased sensitivity of the respiratory center to the action of opioids. This condition contributes to an increase in the frequency of respiratory and other disorders with the use of opioids.
AIM: This work aimed to study the influence of different variants of perioperative anesthesia and analgesia administered during retroperitoneoscopic adrenalectomy in obese patients during the perioperative period.
MATERIALS AND METHODS: A randomized study of 94 patients who underwent retroperitoneoscopic adrenalectomy for adrenal neoplasms was performed. Depending on the type of perioperative analgesia, the patients were divided into two groups. In group 1 (n=33), the operation was performed under combined anesthesia based on the low-flow desflurane inhalation; for perioperative analgesia, only systemic opioid administration was provided. In group 2 (n=30), the operation was performed under anesthesia based on low-flow desflurane inhalation in combination with the blockade of the fascial space of the erector muscle. In group 3 (n=31), the operation was performed under anesthesia based on desflurane in combination with drugs for non-opioid analgesia. critical incidents.
RESULTS: Surgical intervention of the wound under inhalation anesthesia with ESP blockade (ropivacaine) and a combination of drugs for non-opioid analgesia promotes faster post-anesthetic rehabilitation, effective postoperative analgesia, and fewer complications in the early postoperative period compared with anesthesia using systemic opioid analgesics. This effect contributed to significantly shorter hospitalization of 97 hours for group 2 (95% CI 85-102) (p=0,042) and 94 hours for group 3 (95% CI 82-101) (p=0,039) compared with the 126 hours for group 1 (95% CI 114-135).
CONCLUSIONS: Anesthesia based on desflurane in combination with ESP blockade and a multiple drugs for non-opioid anesthesia is an effective method that promotes fast post-anesthesia rehabilitation and shortens the hospitalization period for retroperitoneoscopic adrenalectomy for aldostectomy in the perioperative period.
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Malenkovic, Vesna, Sava Zoric, and Tomislav Randjelovic. "Advantageous usage combined spinal, epidural and general anesthesia versus general anesthesia in abdominal surgery." Srpski arhiv za celokupno lekarstvo 131, no. 5-6 (2003): 232–37. http://dx.doi.org/10.2298/sarh0306232m.
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Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavorable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n=34), was treated with CSEGA and second group of patients (n=33), was treated only with standard (GA). Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure central venous pressure, and dieresis. In the 24 hours postoperative period the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolysm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.
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Neymark, Mikhail I., Roman V. Kiselev, and Evgeniy V. Goncharov. "Erector spinae plane blockade in the complex of anesthesia support of aldosteroma surgery." Regional Anesthesia and Acute Pain Management 15, no. 3 (July 15, 2021): 215–22. http://dx.doi.org/10.17816/1993-6508-2021-15-3-215-222.
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BACKGROUND: The only radical method of treatment of hormonally active adrenal tumors is retroperitoneoscopic adrenalectomy. The modern approach dictates the principles of multimodal analgesia, and avoidance of narcotic analgesics. On the other hand, early activation of such patients in the postoperative period entails a more pronounced postoperative pain syndrome. The relevance of these problems makes us think about better tactics of perioperative management of such patients.
AIM: Feasibility of ESP blockade as a component of analgesia during retroperitoneoscopic surgeries for aldosteroma.
MATERIALS AND METHODS: A randomized study was conducted in 41 patients who underwent retroperitoneoscopic adrenalectomy for aldosteroma. The patients were divided into 2 groups. In the 1st group the operation was carried out under combined anesthesia with Desflurane inhalation and perioperative analgesia by systemic injection of opioids; in the 2nd group the operation was carried out under combined anesthesia with Desflurane inhalation in combination with fascial blockade of the rectifying spine muscle at the operation site by 0.35% Ropivacaine solution.
RESULTS: The use of ESP blockade as an analgesic component of combined anesthesia is indicated for retroperitoneoscopic surgeries for aldosteroma. Firstly, its implementation excludes the use of opioids during anesthesia, which allows to implement the principles of accelerated rehabilitation surgery (ERAS). Secondly, low-flow Desflurane inhalation combined with ESP blockade provides adequate anesthesia during unilateral adrenalectomy for aldosteroma. Thirdly, the analgesic effect of ESP blockade extends to the early postoperative period.
CONCLUSIONS:
The use of ESP block in combination with low flow Desflurane inhalation can be considered as the anesthesia method of choice for retroperitoneoscopic adrenalectomy for aldosteroma.
This technology allows to implement ERAS principles.
The use of ESP block reduces the number of postoperative complications associated with the use of narcotic analgesics.
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Winter, Daiane Cristina, Samuel Monzem, Paulo Roberto Spiller, Matias Bassinello Stocco, Lianna Ghisi Gomes, David Parra Travagin, Elaine Dione Venêga da Conceição, and Luciana Dambrósio Guimarães. "Effects of epidural anesthesia with tramadol, ropivacaine or tramadol-ropivacaine combination, in bitches undergoing ovariohysterectomy under anesthesia with isoflurane." Semina: Ciências Agrárias 37, no. 6 (December 14, 2016): 4063. http://dx.doi.org/10.5433/1679-0359.2016v37n6p4063.
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Epidural anesthesia is a locoregional anesthetic technique that provides analgesia and muscle relaxation in the-retroumbilical region. The combination of opioids and local anesthetics increased the intensity and duration of analgesia by causing immediate motor and sensory nerve blockade, and improved recovery after surgery. The objective was to comparatively evaluate the trans- and postoperative cardiorespiratory and analgesic effects of epidurally administered tramadol, ropivacaine and tramadol-ropivacaine combination in dogs undergoing elective ovariohysterectomy. The effect of isoflurane concentration was also evaluated. This study was performed on 24 female mongrel dogs, pre-medicated with chlorpromazine (0.5 mg kg-1, IV) and, anesthetized with propofol and isoflurane. The dogs were randomly divided into three groups. The first group receveid epidural tramadol (2 mg kg-1, GT group), the second group received ropivacaine (1.5 mg kg-1, GR group), and the third group received a tramadol-ropivacaine combination at the above-mentioned doses (GTR group). At pre-defined time points, classified into pre-, trans-, and postoperative periods, cardiorespiratory variables and analgesia were analyzed for a period of up to 420 min following epidural anesthesia. The check analgesia was check of approximately 105, 217 and 382 minutes, in GR, in GT and GTR respectively, and no cardiovascular and respiratory depression. The drugs used in this study are considered safe and effective for ovariohysterectomy due to the cardiorespiratory stability and trans-operative analgesia provided by them. However, the combination of ropivacaine and tramadol ensured a greater reduction in the inhaled anesthetic dose and better analgesia during in the postoperative period.
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Marova, N. G., Ya I. Vasilyev, E. V. Klyushnikova, A. V. Kononov, and T. S. Polyakova. "LOCAL ANESTHESIA FOR VITREO-RETINAL SURGERY." Regional Anesthesia and Acute Pain Management 12, no. 1 (March 15, 2018): 24–29. http://dx.doi.org/10.18821/1993-6508-2018-12-1-24-29.
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Local anesthesia is used as a component of general anesthesia or self-sufficient technique of perioperative analgesia at the vitreo-retinal surgery. Its popularity originates from safety and simplicity of regional techniques which provide efficient analgesia, perfect surgical field and fast recovery. Most of injection techniques of ophthalmic regional anesthesia are single shot methods which could not provide effective analgesia in some patients who required anesthesia for a prolonged period. Implementation of catheter technique in daily practice could be solution to this problem. Infusion of local anesthetic through catheter possesses all advantages of single-shot techniques and provides virtually unlimited duration of analgesia.
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Hekmat, Khosro. "Analgesie nach VATS-Lobektomie: Vorteile der patientengesteuerten Schmerztherapie nutzen." Kompass Pneumologie 8, no. 2 (2020): 80–81. http://dx.doi.org/10.1159/000505945.
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Background: The optimal perioperative analgesic strategy in video-assisted thoracic surgery (VATS) for anatomic lung resections remains an open issue. Regional analgesic concepts as thoracic paravertebral or epidural analgesia were used as systemic opioid application. We hypothesized that regional anesthesia would provide improved analgesia compared to systemic analgesia with parenteral opioids in VATS lobectomy and would be associated with a lower incidence of pulmonary complications. Methods: The study was approved by the local ethics committee (AZ 99/15) and registered (germanctr.de; DRKS00007529, 10th June 2015). A retrospective analysis of anesthetic and surgical records between July 2014 und February 2016 in a single university hospital with 103 who underwent VATS lobectomy. Comparison of regional anesthesia (i.e. thoracic paravertebral blockade (group TPVB) or thoracic epidural anesthesia (group TEA)) with a systemic opioid application (i.e. patient controlled analgesia (group PCA)). The primary endpoint was the postoperative pain level measured by Visual Analog Scale (VAS) at rest and during coughing during 120 h. Secondary endpoints were postoperative pulmonary complications (i.e. atelectasis, pneumonia), hemodynamic variables and postoperative nausea and vomiting (PONV). Results: Mean VAS values in rest or during coughing were measured below 3.5 in all groups showing effective analgesic therapy throughout the observation period. The VAS values at rest were comparable between all groups, VAS level during coughing in patients with PCA was higher but comparable except after 8-16 h postoperatively (PCA vs. TEA; p < 0.004). There were no significant differences on secondary endpoints. Intraoperative Sufentanil consumption was significantly higher for patients without regional anesthesia (p < 0.0001 vs. TPVB and vs. TEA). The morphine equivalence postoperatively applicated until POD 5 was comparable in all groups (mean ± SD in mg: 32 ± 29 (TPVB), 30 ± 27 (TEA), 36 ± 30 (PCA); p = 0.6046). Conclusions: Analgesia with TEA, TPVB and PCA provided a comparable and effective pain relief after VATS anatomic resection without side effects. Our results indicate that PCA for VATS lobectomy may be a sufficient alternative compared to regional analgesia. Trial registration: The study was registered (germanctr.de; DRKS00007529; 10th June, 2015).
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Reuben, Scott S., Robert B. Steinberg, Jonathan L. Klatt, and Margaret L. Klatt. "Intravenous Regional Anesthesia Using Lidocaine and Clonidine." Anesthesiology 91, no. 3 (September 1, 1999): 654. http://dx.doi.org/10.1097/00000542-199909000-00015.
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Background Clonidine has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The authors postulated that using clonidine as a component of intravenous regional anesthesia (IVRA) would enhance postoperative analgesia. Methods Forty-five patients undergoing ambulatory hand surgery received IVRA with lidocaine, 0.5%, and were assigned randomly and blindly to three groups. The control group received intravenous saline, the intravenous clonidine group received 1 microg/kg clonidine intravenously, and the IVRA clonidine group received 1 microg/kg clonidine as part of the IVRA solution. After their operations, the patients' pain and sedation scores and analgesic use were recorded. Results Patients in the IVRA clonidine group had a significantly longer period of subjective comfort when they required no analgesics (median [range]) for 460 min (215-1,440 min), compared with 115 min (14-390 min) for the control group and 125 min (17-295 min) for the intravenous clonidine group (P<0.0001). The patients who received IVRA with clonidine reported significantly lower pain scores 1 and 2 h after tourniquet deflation compared with the other groups, and they required no fentanyl in the postanesthesia care unit. They also required fewer analgesic tablets (325 mg acetaminophen with 30 mg codeine) in the first 24 h (2+/-1, mean +/- SD) compared with the other two groups, 5+/-1 tablets (control) and 4+/-2 tablets (intravenous clonidine) (P<0.0001). No significant postoperative sedation, hypotension, or bradycardia developed in any of the patients. Conclusion The addition of 1 microg/kg clonidine to lidocaine, 0.5%, for IVRA in patients undergoing ambulatory hand surgery improves postoperative analgesia without causing significant side effects during the first postoperative day.
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E.M., Nasibova, and Poluxovr SH. "Combination of Dexmedetomidine and Bupivacaine for Caudal Anesthesia In Children." Pakistan Journal of Medical and Health Sciences 15, no. 7 (July 30, 2021): 1999–2000. http://dx.doi.org/10.53350/pjmhs211571999.
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Background: Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Aim: To evaluate the efficacy and safety of the caudal use of dexmedetomidine in caudal anesthesia in children. Methods: The subject of the study was 46 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Results: The duration of caudal analgesia was determined from the moment the anesthetic was injected until the moment the child first complained of pain or the time when the first postoperative analgesia was required. The average duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. More data is also needed on the neurological safety of dexmedetomidine. Key words: dexmedetomidine,caudal block, bupivacaine.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 21, no. 1 (March 2001): 25–37. http://dx.doi.org/10.1097/00132582-200103000-00005.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 21, no. 1 (March 2001): 38–39. http://dx.doi.org/10.1097/00132582-200103000-00006.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 21, no. 2 (June 2001): 68–70. http://dx.doi.org/10.1097/00132582-200106000-00005.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 21, no. 2 (June 2001): 70–83. http://dx.doi.org/10.1097/00132582-200106000-00006.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 21, no. 2 (June 2001): 84–85. http://dx.doi.org/10.1097/00132582-200106000-00007.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 22, no. 1 (March 2002): 29–41. http://dx.doi.org/10.1097/00132582-200203000-00005.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 22, no. 1 (March 2002): 41–43. http://dx.doi.org/10.1097/00132582-200203000-00006.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 22, no. 2 (June 2002): 78–79. http://dx.doi.org/10.1097/00132582-200206000-00007.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 22, no. 2 (June 2002): 79. http://dx.doi.org/10.1097/00132582-200206000-00008.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 22, no. 2 (June 2002): 80–99. http://dx.doi.org/10.1097/00132582-200206000-00009.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 22, no. 2 (June 2002): 99–101. http://dx.doi.org/10.1097/00132582-200206000-00010.
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&NA;. "ANESTHESIA—ANALGESIA." Obstetric Anesthesia Digest 22, no. 4 (December 2002): 197–98. http://dx.doi.org/10.1097/00132582-200212000-00006.
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&NA;. "ANESTHESIA—ANALGESIA." Obstetric Anesthesia Digest 22, no. 4 (December 2002): 198–208. http://dx.doi.org/10.1097/00132582-200212000-00007.
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&NA;. "ANESTHESIA—ANALGESIA." Obstetric Anesthesia Digest 22, no. 4 (December 2002): 208–12. http://dx.doi.org/10.1097/00132582-200212000-00008.
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Lee, Jeffrey S. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 23, no. 1 (January 2003): 33–35. http://dx.doi.org/10.1097/00132582-200301000-00007.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 23, no. 1 (January 2003): 35–42. http://dx.doi.org/10.1097/00132582-200301000-00008.
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&NA;. "ANESTHESIA–ANALGESIA." Obstetric Anesthesia Digest 23, no. 1 (January 2003): 42–44. http://dx.doi.org/10.1097/00132582-200301000-00009.
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&NA;. "ANESTHESIA—ANALGESIA." Obstetric Anesthesia Digest 23, no. 4 (October 2003): 179–80. http://dx.doi.org/10.1097/00132582-200310000-00005.
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&NA;. "ANESTHESIA—ANALGESIA." Obstetric Anesthesia Digest 23, no. 4 (October 2003): 180–87. http://dx.doi.org/10.1097/00132582-200310000-00006.
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&NA;. "ANESTHESIA—ANALGESIA." Obstetric Anesthesia Digest 23, no. 4 (October 2003): 187–88. http://dx.doi.org/10.1097/00132582-200310000-00007.
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Gami, Rupesh Kumar, Kumar Jahan, and Chandra Bhushan Jha. "Efficacy and safety of intrathecal morphine for post cesarean section analgesia." Journal of Society of Anesthesiologists of Nepal 1, no. 1 (October 3, 2015): 13–17. http://dx.doi.org/10.3126/jsan.v1i1.13583.
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Background: Government of Nepal has been conducting Cesarean section under “Safe Motherhood” program all over country. The purpose of this study was to evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia. Methods: A total of 300 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 150 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24 hr, nausea, vomiting, pruritus, sedation and respiratory depression.Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1 ± 7.6 vs 3.7 ± 2.9 hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7 ± 2.0 vs 3.4 ± 8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus. Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.Journal of Society of Anesthesiologists 2014 1(1): 13-17
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Satvaldieva, Elmira A., Otabek Ya Fayziev, and Anvar S. Yusupov. "Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology." Russian Pediatric Journal 24, no. 1 (March 12, 2021): 27–31. http://dx.doi.org/10.46563/1560-9561-2021-24-1-27-31.
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Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.
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Pathak, Laxmi. "EFFECT OF POSTOPERATIVE EPIDURAL ANALGESIA AFTER MAJOR ORTHOPEDIC SURGERIES, A RETROSPECTIVE STUDY." Journal of Universal College of Medical Sciences 3, no. 2 (January 11, 2016): 20–25. http://dx.doi.org/10.3126/jucms.v3i2.14286.
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INTRODUCTION: Epidural analgesia has been used in many major surgeries like upper abdominal surgery, cardio-thoracic surgery, orthopedic surgery etc. Epidural analgesia is one of the commonly used methods of postoperative pain control despite its associated complications. So, this study was conducted to find out its effectiveness in major orthopedic surgeries done in Universal College of Medical Sciences. MATERIAL AND METHODS: A retrospective study was done at Universal College of Medical Sciences & Teaching Hospital, Bhairahawa, Nepal from July 2012 to June 2014. Data of 57 patients, aged between 17 to 91 years having American Society of Anesthesiologists (ASA) physical status 1 and 2 who had undergone major orthopedic surgeries under spinal anesthesia and lumber epidural catheterization were collected and important information regarding anesthesia and surgery, epidural catheter and postoperative epidural analgesia, any complications if occurred throughout the study period were recorded. Departmental Protocol for epidural analgesia was followed in these patients. Patients who received intraoperative epidural anesthesia or analgesia and any other anesthetic or analgesic agents were excluded in this study. RESULTS: This study found epidural analgesia, a very effective way to relieve pain in patients undergoing major orthopedic surgeries, when given according to the Departmental Protocol. There were no any complications related to epidural analgesia till 4th postoperative day. Out of 57, only 2 patients received injection Ketorolac intravenously as a rescue analgesic at the same day of operation before epidural top up. Average time to demand for analgesic after the last dose of epidural top up was 21.933 hours. All patients were mobilized around their beds on 2nd postoperative day. The average postoperative days of hospital stay was only 6.5 days. CONCLUSION: Epidural mixture of Bupivacaine-morphine in lower dose and concentration given as an intermittent bolus dosing via lumber epidural catheter is safe and very effective in relieving postoperative pain after major orthopedic surgeries without any significant complications.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10
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Reitz, Jeffrey A. "Alfentanil in Anesthesia and Analgesia." Drug Intelligence & Clinical Pharmacy 20, no. 5 (May 1986): 335–41. http://dx.doi.org/10.1177/106002808602000501.
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Alfentanil is a tetrazole derivative of fentanyl. Many of the pharmacologic effects of alfentanil are similar to those of fentanyl and sufentanil, but of quicker onset than those of fentanyl and of shorter duration than those of fentanyl and sufentanil. Alfentanil may cause less intense respiratory depression than equianalgesic doses of fentanyl. Alfentanil has a lower total body clearance, smaller volume of distribution, and shorter half-life than fentanyl and sufentanil. Clinical trials indicate alfentanil can be used effectively as an analgesic, an analgesic supplement to anesthesia, an anesthetic induction agent, and as the major component of a general anesthetic. Its short duration of effect makes it attractive as an analgesic supplement for short ambulatory surgical procedures. Alfentanil is recommended for addition to drug formularies, but its use should be restricted to anesthesia personnel.
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Stamenkovic, Dusica M., Mihailo Bezmarevic, Suzana Bojic, Dragana Unic-Stojanovic, Dejan Stojkovic, Damjan Z. Slavkovic, Vladimir Bancevic, Nebojsa Maric, and Menelaos Karanikolas. "Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review." Journal of Clinical Medicine 10, no. 20 (October 11, 2021): 4659. http://dx.doi.org/10.3390/jcm10204659.
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Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.
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Saylan, Sedat, Ahmet Eroglu, and Davut Dohman. "The Effects of Single-Dose Rectal Midazolam Application on Postoperative Recovery, Sedation, and Analgesia in Children Given Caudal Anesthesia Plus Bupivacaine." BioMed Research International 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/127548.
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Background. This study aimed to compare the effects of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time, the need for additional analgesics, postoperative recovery, and sedation and to find out its adverse effects in children having lower abdominal surgery.Methods. 40 children between 2 and 10 years of ASA I-II were randomized, and they received caudal anesthesia under general anesthesia. Patients underwent the application of caudal block in addition to saline and 1 mL/kg bupivacaine 0.25%. In the postoperative period, Group C (n= 20) was given 5 mL saline, and Group M (n= 20) was given 0.30 mg/kg rectal midazolam diluted with 5 mL saline. Sedation scale and postoperative pain scale (CHIPPS) of the patients were evaluated. The patients were observed for their analgesic need, first analgesic time, and adverse effects for 24 hours.Results. Demographic and hemodynamic data of the two groups did not differ. Postoperative sedation scores in both groups were significantly lower compared with the preoperative period. There was no significant difference between the groups in terms of sedation and sufficient analgesia.Conclusions. We conclude that caudal anesthesia provided sufficient analgesia in peroperative and postoperative periods, and rectal midazolam addition did not create any differences. This trial is registered with ClinicalTrials.govNCT02127489.
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Arunkumar Arumugam, Bharti Badlani, Puja Singh, and Sonali Tripathi. "Efficacy of clonidine as an additive to levobupivacaine for epidural anesthesia and post-operative analgesia in infraumbilical surgeries – A randomized and double blind study." Asian Journal of Medical Sciences 13, no. 10 (October 1, 2022): 47–53. http://dx.doi.org/10.3126/ajms.v13i10.45813.
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Background: Epidural anesthesia as a safe alternative to general anesthesia is commonly used for inducing anesthesia and post-operative analgesia in patients undergoing infraumbilical surgeries. The addition of an adjuvant not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in the dose of rescue analgesic agent in post-operative period. Clonidine is a potent and selective α-2-adrenoceptor agonist with analgesic potency. Aims and Objectives: This study was conducted to evaluate the efficacy of clonidine as an additive to levobupivacaine in infraumbilical surgeries. Materials and Methods: One hundred patients of American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were randomly divided into two groups as levobupivacaine (L) and levobupivacaine with clonidine (LC). Patients were allocated to one of the two groups by computer generated random selection. Group L received 0.5% levobupivacaine (1.5 mg/kg) and Group LC received 0.5% levobupivacaine (1.5 mg/kg) with clonidine (2 μg/kg). The onset time for sensory, motor blockade, duration of anesthesia and duration of analgesia, and Visual Analog Scale (VAS) score were observed in both the groups. The hemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation at various time intervals were measured. Any untoward side effects were noted in both groups. Results: The onset of sensory (7.8±1.7 min) and motor blockade (10.9±1.9 min) were significantly faster in clonidine group. Duration of anesthesia and duration of analgesia were prolonged in Group LC (234.5±16.1 min, 412.8±48.3 min) compared to Group L (173.56±12.78 min, 269.2±24.2 min) which was statistically significant (P<0.05). Similarly, clonidine group had less VAS score compared to control group. There was no significant change in the hemodynamic variables between the two groups. Hypotension and bradycardia were found more in clonidine group compared to the control group. Conclusion: Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anesthesia for infraumbilical surgeries.
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Wuethrich, Patrick Y., Shu-Fang Hsu Schmitz, Thomas M. Kessler, George N. Thalmann, Urs E. Studer, Frank Stueber, and Fiona C. Burkhard. "Potential Influence of the Anesthetic Technique Used during Open Radical Prostatectomy on Prostate Cancer-related Outcome." Anesthesiology 113, no. 3 (September 1, 2010): 570–76. http://dx.doi.org/10.1097/aln.0b013e3181e4f6ec.
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Background Recently published studies suggest that the anesthetic technique used during oncologic surgery affects cancer recurrence. To evaluate the effect of anesthetic technique on disease progression and long-term survival, we compared patients receiving general anesthesia plus intraoperative and postoperative thoracic epidural analgesia with patients receiving general anesthesia alone undergoing open retropubic radical prostatectomy with extended pelvic lymph node dissection. Methods Two sequential series were studied. Patients receiving general anesthesia combined with epidural analgesia (January 1994-June 1997, n=103) were retrospectively compared with a group given general anesthesia combined with ketorolac-morphine analgesia (July 1997-December 2000, n=158). Biochemical recurrence-free survival, clinical progression-free survival, cancer-specific survival, and overall survival were assessed using the Kaplan-Meier technique and compared using a multivariate Cox-proportional-hazards regression model and an alternative model with inverse probability weights to adjust for propensity score. Results Using propensity score adjustment with inverse probability weights, general anesthesia combined with epidural analgesia resulted in improved clinical progression-free survival (hazard ratio, 0.45; 95% confidence interval, 0.27-0.75, P=0.002). No significant differences in the two groups were found for biochemical recurrence-free survival, cancer-specific survival, or overall survival. Higher preoperative serum values for prostate-specific antigen, specimen Gleason score of at least 7, non-organ-confined tumor stage, and positive lymph node status were independent predictors of biochemical recurrence-free survival. Conclusions General anesthesia with epidural analgesia was associated with a reduced risk of clinical cancer progression. However, no significant difference was found between general anesthesia plus postoperative ketorolac-morphine analgesia and general anesthesia plus intraoperative and postoperative thoracic epidural analgesia in biochemical recurrence-free survival, cancer-specific survival, or overall survival.
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Martin, Lizabeth D., Nathalia Jimenez, and Anne M. Lynn. "A review of perioperative anesthesia and analgesia for infants: updates and trends to watch." F1000Research 6 (February 8, 2017): 120. http://dx.doi.org/10.12688/f1000research.10272.1.
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This review focuses on pharmacokinetics and pharmacodynamics of opioid and non-opioid analgesics in neonates and infants. The unique physiology of this population differs from that of adults and impacts drug handling. Morphine and remifentanil are described as examples of older versus recently developed opiates to compare and contrast pharmacokinetics and pharmacodynamics in infants. Exploration of genetics affecting both pharmacokinetics and pharmacodynamics of opiates is an area of active research, as is the investigation of a new class of mu-opiate-binding agents which seem selective for analgesic pathways while having less activity in pathways linked to side effects. The kinetics of acetaminophen and of ketorolac as examples of parenteral non-steroidal analgesics in infants are also discussed. The growth in regional anesthesia for peri-operative analgesia in infants can fill an important role minimizing intra-operative anesthetic exposure to opioids and transitioning to post-operative care. Use of multi-modal techniques is recommended to decrease undesirable opiate-related side effects in this vulnerable population.
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Hu, Bingwei, Hongwei Wang, Tingting Ma, Zhimei Fu, and Zhiying Feng. "Effect Analysis of Epidural Anesthesia with 0.4% Ropivacaine in Transforaminal Endoscopic Surgery." Journal of Healthcare Engineering 2021 (October 6, 2021): 1–6. http://dx.doi.org/10.1155/2021/2929843.
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Background. Epidural anesthesia used in percutaneous endoscopic lumber discectomy (PELD) has the risk of complete neurotactile block. Patients cannot timely respond to the operator when the nerve is touched by mistake, so the potential risk of nerve injury cannot be avoided. According to pharmacodynamics, with the decrease of local anesthetic concentration, the nerve tactile gradually recovered; however, the analgesic effect also gradually weakened. Therefore, it is necessary to explore an appropriate concentration of local anesthetics that can keep the patients’ nerve touch without pain. By comparing the advantages and disadvantages of 0.4% ropivacaine epidural anesthesia, local anesthesia and intravenous anesthesia on intraoperative circulation fluctuation, the incidence of salvage analgesia and the incidence of nerve non-touch, the feasibility of using low concentration epidural anesthesia in PELD to obtain enough analgesia and avoid the risk of nerve injury was confirmed. Methods. 153 cases of intervertebral foramen surgery from October 2017 to January 2020 were selected and divided into local anesthesia group (LA group), 0.4% ropivacaine epidural anesthesia group (EA group), and intravenous anesthesia group (IVA group) according to different anesthesia methods. The changes of blood pressure and heart rate, the incidence of rescue analgesia and nerve root non-touch were compared among the three groups. Results. The difference of map peak value among the three groups was statistically significant ( P < 0.001 ); pairwise comparison showed that the map peak value of the LA group was higher than that of the EA group ( P < 0.001 ) and IVA group ( P < 0.001 ), but there was no statistical significance between the EA group and IVA group. The difference of HR peak value among the three groups was statistically significant; pairwise comparison showed that the HR peak value of the LA group was higher than that of the EA group ( P < 0.001 ) and IVA group ( P < 0.001 ), but there was no statistical significance between the EA group and IVA group. There was significant difference in the incidence of intraoperative hypertension among the three groups ( P < 0.05 ); pairwise comparison showed that the incidence of intraoperative hypertension in the EA group was lower than that in the LA group ( P < 0.05 ), while there was no significant difference between the IVA group, EA group, and LA group. There was significant difference in the incidence of rescue analgesia among the three groups ( P < 0.01 ); pairwise comparison showed that the incidence of rescue analgesia in the EA group was lower than that in the LA group ( P < 0.05 ) and IVA group ( P < 0.05 ), but there was no significant difference between the LA group and IVA group. Due to the different analgesic mechanisms of the three anesthesia methods, local anesthesia and intravenous anesthesia do not cause the loss of nerve tactile, while the incidence of nerve tactile in 0.4% ropivacaine epidural anesthesia is only 2.4%, which is still satisfactory. Conclusion. Epidural anesthesia with 0.4% ropivacaine is a better anesthesia method for PELD. It not only has a low incidence of non-tactile nerve, but also has perfect analgesia and more stable intraoperative circulation.
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Scott, Grace M., Chris Diamond, and Damian C. Micomonaco. "Assessment of a Lateral Nasal Wall Block Technique for Endoscopic Sinus Surgery Under Local Anesthesia." American Journal of Rhinology & Allergy 32, no. 4 (April 23, 2018): 318–22. http://dx.doi.org/10.1177/1945892418770263.
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Introduction With increasingly limited operative resources and patient desires for minimally invasive procedures, there is a trend toward local endoscopic procedures being performed in the outpatient clinic setting. However, there remain limited data supporting a technique to adequately anesthetize the lateral nasal wall and provide patient comfort during these procedures. The objective of this study is to assess the efficacy of a novel lateral nasal wall block for use in office-based endoscopic sinus surgery. Methods A prospective cohort study assessing consecutive patients undergoing office-based endoscopic sinus surgery using our described lateral nasal wall block anesthesia technique. Procedural patient comfort was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS), completed by participants immediately following an office-based endoscopic procedure and prior to discharge from clinic. Postoperative analgesic use was assessed at the first postoperative visit. Results Thirty-five consecutive patients undergoing office-based outpatient endoscopic sinus surgery for chronic rhinosinusitis (with and without polyps) were assessed. The mean ISAS score was 2.83 (95% confidence interval: [2.69, 2.97]). All participants (100%) agree or strongly agree that they were satisfied with their anesthesia care and would want the same anesthetic again. No participant required narcotic analgesia, and 80% used no oral analgesia following the procedure. Conclusions Recent advances in office-based endonasal surgical procedures must be accompanied by the assessment and validation of local anesthetic techniques. The described novel lateral nasal wall block is well tolerated, provides patient satisfaction, and allows for limited use of postprocedure oral analgesics.
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Slavchev, Stanislav, and Angel Yordanov. "Basic principles of anesthesia and postoperative analgesia in patients operated within an enhanced recovery after surgery (ERAS) protocol." Journal of medical pharmaceutical and allied sciences 11, no. 2 (March 30, 2022): 4752–56. http://dx.doi.org/10.55522/jmpas.v11i2.3088.
Full textAbstract:
The Enhanced Recovery After Surgery (ERAS) system is a collection of preoperative, intraoperative, and early postoperative measures. The primary goal of gynecological surgery is a rapid and uneventful recovery from oncological and standard procedures, particularly in patients over the age of 65. The goal is to achieve comparable results to those obtained with minimally invasive procedures. Certain features of the ERAS system are similar to those of standard surgical procedures. These are the measures taken to prevent thromboembolism and to promote early postoperative mobility. Anesthesia and postoperative analgesia are critical components of achieving the ERAS system's objectives. The ERAS protocol requires multimodal non-opioid postoperative analgesia, infiltration of the surgical wound with a local anesthetic, and avoidance of opioid analgesics. We discuss current data on patient management according to the ERAS protocol for anesthesia and analgesia in order to minimize the body's stress reactions, promote early mobility, and reduce postoperative complications. ERAS protocol has gained popularity in recent years in a number of centers, primarily in the United States and Europe, due to its direct impact on hospital stay length, healthcare costs, and benefits for patients, their relatives, and caregivers. Keywords: ERAS protocol; multimodal opioid-sparing analgesia; local infiltration anesthesia.