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Postoperative Hours (postoperative + hour)
Selected AbstractsComparison of a bupivacaine 0.5% and lidocaine 2% mixture with levobupivacaine 0.75% and ropivacaine 1% in peribulbar anaesthesia for cataract surgery with phacoemulsificationACTA OPHTHALMOLOGICA, Issue 8 2007Mehmet Borazan Abstract. Purpose:, To compare a bupivacaine and lidocaine mixture with levobupivacaine and ropivacaine in terms of safety, efficacy and blocking quality in peribulbar anaesthesia for phacoemulsification. Methods:, A total of 105 patients scheduled for cataract surgery with peribulbar anaesthesia were randomly allocated into three groups of 35 patients each, to receive 5 ml of, respectively, a 1 : 1 mixture of bupivacaine 0.5% and lidocaine 2% (group 1), levobupivacaine 0.75% (group 2), or ropivacaine 1% (group 3). Ocular movement scores were evaluated at 2, 4, 6, 8 and 10 mins after injection. Intraoperative and postoperative analgesia were evaluated by verbal pain scores. Duration of surgery, need for supplementary anaesthesia, haemodynamic parameters and the incidence of perioperative complications were recorded. Results:, The ocular movement score in min 2 was significantly lower in group 1. There was no significant difference between groups 2 and 3. Ocular movement scores at mins 4 and 6 were significantly decreased in group 1 and 2 compared with group 3. There was no significant difference among the groups in ocular movement scores at mins 8 and 10. Verbal pain scores in postoperative hour 4 were highest in group 3, but scores for the intraoperative period and postoperative hours 1 and 2 were similar among the groups. Duration of surgery and haemodynamic parameters did not differ among the groups. Conclusions:, All agents were considered to be convenient for clinical use in cataract surgery with peribulbar anaesthesia. Although the ocular movement scores in the ropivacaine group were higher than in the other groups at mins 4 and 6, this did not imply any clinical significance. [source] Living without aprotinin: the results of a 5-year blood saving program in cardiac surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009M. RANUCCI Background: After 20 years of regular use in cardiac surgery patients, aprotinin has recently been withdrawn from the market due to many concerns about its safety. For a number of reasons aprotinin has not been available in Italy since 1998. The present study presents an aprotinin-free treatment protocol applied at our institution during the last 5 years, and aims to verify the results of this protocol in terms of allogeneic blood product transfusions, postoperative blood loss and surgical re-exploration rate. Methods: Retrospective study on 7988 consecutive patients who underwent cardiac surgery during the years 2003,2007. All the patients received specific hemostasis/coagulation management based on (a) routine use of tranexamic acid, (b) heparin dose,response monitoring, thromboelastography, platelet (PLT) function analysis in a select population of patients, and (c) use of fresh frozen plasma (FFP), PLTs, and desmopressin according to the hemostasis/coagulation profile. Data retrieved from the institutional database were quantity of packed red cells (PRCs), FFP, PLT transfusion rate, blood loss in the first 12 postoperative hours, and surgical re-exploration rate. Results: PRCs were transfused in 40.4% of patients (with higher rates for selected high-risk subpopulations), FFP in 12.9% and PLTs in 2.6%. Surgical re-exploration rate was 3.7%. With respect to historical controls, a significant reduction of PRCs and FFP transfusions was obtained using closed circuits, point of care coagulation tests, and combination of the two. Conclusion: This aprotinin-free blood saving program is an effective strategy for allogeneic blood products transfusion containment. [source] Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidineACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2002I. Dobrydnjov Background: The purpose of the present study was to evaluate the postoperative analgesic and adverse effects of equal doses of oral or intrathecal clonidine in spinal anaesthesia with bupivacaine plain. Methods: Forty-five ASA I-III orthopaedic patients scheduled for osteosynthesis of a traumatic femur fracture were randomised in a double-blind fashion to one of 3 groups. Patients received 15 mg of plain bupivacaine intrathecally (group B) or an intrathecal mixture of bupivacaine 15 mg and clonidine 150 mg (group CIT). In group CPO oral clonidine 150 mg was administered 60 min before intrathecal injection of bupivacaine 15 mg. Results: Oral and intrathecal clonidine prolonged the time until the first request for analgesics, 313 ± 29 and 337 ± 29 min, respectively, vs. 236 ± 27 min in group B (P < 0.01). The total 24- h PCA morphine dose was significantly lower in group CIT(19.3 ± 1.3 mg) compared to groups B and CPO(33.4 ± 2.0 and 31.2 ± 3.1 mg). MAP was decreased significantly during the first hour after intrathecal clonidine(14%) and during the first 5 h after oral clonidine(14,19%). HR decreased in CIT during the 5th and 6th postoperative hours(7,9%) and during the first 2 h(9%) in CPO (P < 0.01). The degree of sedation was more pronounced in group CPO during the first 3 h. Four patients had pruritus in group B. Conclusions: Addition of intrathecal clonidine prolonged analgesia and decreased morphine consumption postoperatively more than oral clonidine. Hypotension was more pronounced after oral than after intrathecal clonidine. Intrathecal clonidine is therefore recommended. [source] Addition of clonidine and fentanyl: comparison between three different regional anesthetic techniques in circumcisionPEDIATRIC ANESTHESIA, Issue 11 2005ZOUHER A NAJA MD Summary Background :,Several techniques have been used for alleviating postcircumcision pain with regional anesthetics being more effective than systemic opioids. Our aim was to compare the effectiveness of dorsal penile block, ring block (RB) and dorsal penile block associated with RB in reducing postcircumcision pain in children. Methods :,We conducted a prospective randomized double-blind clinical trial on 100 boys aged between 1 month and 5 years undergoing elective circumcision. Each 20 ml of local anesthetic mixture contained 9 ml lidocaine 1% without epinephrine, 9 ml bupivacaine 0.5%, 1 ml fentanyl (50 ,g·ml,1) and 1 ml clonidine (75 ,g·ml,1). They were allocated to one of three groups: 33 boys were given a RB with 1,1.5 ml (group 1), 32 had a dorsal penile block with 1.5,4 ml (group 2) and 35 had a combined ring and dorsal penile block with 2.5,5 ml of anesthetic mixture based on the child's age. Results :,Ninety-one children (91%) completed the clinical trial (three failed blocks and six follow-up losses). The groups were similar with regard to age, weight, height, duration of surgery and hemodynamic status. The average pain scores were significantly higher with a RB compared with the other two groups (P < 0.05) for the first postoperative day. RB children and dorsal penile block children consumed significantly more analgesics for the first six postoperative hours (P < 0.05). The surgeon's satisfaction was significantly higher with the ring + dorsal penile block group (100%) compared with the other two groups (P = 0.032). Conclusion :,Dorsal penile block plus RB technique is superior to dorsal penile block alone and RB alone in reducing postcircumcision pain in children. [source] Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric casesPEDIATRIC ANESTHESIA, Issue 3 2001Corinne Lejus MD Background: The objective of this prospective study was the evaluation of the analgesia provided by an epidural infusion of bupivacaine and fentanyl after different types of surgery in children. Methods: Data were collected from 348 epidural analgesia in 87 children below 2 years of age, in 80 children between 2 and 6 years and 181 above 6 years of age, for a median duration of 43 postoperative hours. Bupivacaine (mean concentration 0.185%) and fentanyl (5 ,g·kg,1·day,1) were administered on the surgical ward. Results: Pain control was considered excellent in 86% of the 11 072 pain hourly assessments. Analgesia was found to be better for children older than 2 years, and the overall quality of their night's sleep was better than that of older children. Higher pain scores were noted for Nissen fundoplication surgery and club foot repairs. Early discontinuation rarely occurred, and only because of technical problems with the epidural catheter (4%) or insufficient analgesia (6%). Complications were minor (nausea/vomiting 14%, pruritus 0.6%, urinary retention 17%) and easily reversed. Conclusions: This combination of bupivacaine,fentanyl provides safe analgesia after major surgery in children with frequent clinical monitoring. Regular pain assessments of intensity and duration are useful to improve the quality of postoperative analgesia. [source] Comparison of a bupivacaine 0.5% and lidocaine 2% mixture with levobupivacaine 0.75% and ropivacaine 1% in peribulbar anaesthesia for cataract surgery with phacoemulsificationACTA OPHTHALMOLOGICA, Issue 8 2007Mehmet Borazan Abstract. Purpose:, To compare a bupivacaine and lidocaine mixture with levobupivacaine and ropivacaine in terms of safety, efficacy and blocking quality in peribulbar anaesthesia for phacoemulsification. Methods:, A total of 105 patients scheduled for cataract surgery with peribulbar anaesthesia were randomly allocated into three groups of 35 patients each, to receive 5 ml of, respectively, a 1 : 1 mixture of bupivacaine 0.5% and lidocaine 2% (group 1), levobupivacaine 0.75% (group 2), or ropivacaine 1% (group 3). Ocular movement scores were evaluated at 2, 4, 6, 8 and 10 mins after injection. Intraoperative and postoperative analgesia were evaluated by verbal pain scores. Duration of surgery, need for supplementary anaesthesia, haemodynamic parameters and the incidence of perioperative complications were recorded. Results:, The ocular movement score in min 2 was significantly lower in group 1. There was no significant difference between groups 2 and 3. Ocular movement scores at mins 4 and 6 were significantly decreased in group 1 and 2 compared with group 3. There was no significant difference among the groups in ocular movement scores at mins 8 and 10. Verbal pain scores in postoperative hour 4 were highest in group 3, but scores for the intraoperative period and postoperative hours 1 and 2 were similar among the groups. Duration of surgery and haemodynamic parameters did not differ among the groups. Conclusions:, All agents were considered to be convenient for clinical use in cataract surgery with peribulbar anaesthesia. Although the ocular movement scores in the ropivacaine group were higher than in the other groups at mins 4 and 6, this did not imply any clinical significance. [source] | ||||||||||