To assess our study design and to obtain preliminary data for a dose-effect study on levobupivacaine for caudal analgesia in patients undergoing hypospadias repair. non randomised, non-blinded pilot study. For this non-randomized, non-blinded pilot study, 20 patients (median age 17 months, median weight 10.5 kg) were allocated to two groups receiving ...

To investigate safety and efficacy of 0.5% morphine drops for pain control after photorefractive keratectomy (PRK). In a double-blind prospective study, 40 patients were randomized to either 0.5% morphine drops (n=20) or vehicle control (n=20). Treatment occurred every 2 hours following PRK on the day of the procedure, then four ...

BACKGROUND: This study attempts to determine whether preemptive thoracic epidural analgesia (TEA) initiated before surgical incision would reduce the severity of acute post-thoracotomy pain, its effects on pulmonary function and stress response. METHODS: Forty patients undergoing posterolateral thoracotomy received TEA either before (preoperative-TEA group) or after (postoperative-TEA group) surgery. Postoperative ...

Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the ED. A concentrated solution of fentanyl (300 microg/mL) has been used in prior trials, yet many ED use the standard solution at a concentration of 50 microg/mL, which is widely available and of low cost. We set out to ...

BACKGROUND AND OBJECTIVES: Patients who received NCA with morphine following major surgery between 1996 and 2008 at Great Ormond Street Hospital, London, UK, were prospectively studied in the postoperative period to determine effectiveness, morphine requirements, incidence of common side effects, and serious adverse events. METHODS: The morphine NCA regimen and ...

Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and ...

OBJECTIVE: To investigate the effects of acupuncture on the morphine-related side effects (nausea, vomiting, itchiness and gastrointestinal disorders) in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture. METHODS: Patients scheduled to have transurethral prostatic resection: enrolled in the study (69 patients), characterized as Grade ...

BACKGROUND: During combined general and regional anaesthesia, it is difficult to use autonomic signs to assess whether wakefulness is suppressed adequately. We compared the effects of a dexmedetomidine-bupivacaine mixture with plain bupivacaine for thoracic epidural anaesthesia on intraoperative awareness and analgesic benefits, when combined with superficial isoflurane anaesthesia (<0.05 maximum ...

A retrospective analysis of 659 patients who had undergone a hip or knee arthroplasty was undertaken to determine the incidence of pulmonary embolism (PE) during the 48-hour period following surgery. Data related to pain control, concomitant medications, length of stay, and adverse reactions were also collated. Patients were evenly divided ...

Ketamine was recently shown to attenuate postoperative pain when used in combination with morphine in patients who had undergone general and orthopedic surgery. We assessed its effects in 46 patients undergoing minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, or thoracotomy and correlated them with patient and family ...

The purpose of this study was to evaluate the analgesic effect of single-dose preoperative gabapentin on postoperative pain and morphine consumption after cardiac surgery. A randomized, double-blind, placebo-controlled, clinical study. A single university hospital. Sixty patients undergoing coronary artery bypass graft surgery. Patients were randomly allocated into 2 groups preoperatively ...

Perioperative Thoracic epidural analgesia (TEA) is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a randomized clinical trial at tertiary care cardiac institute ...

Venous ischemia is a major cause of failure after free tissue transfers and replantations. The combination of general and epidural anesthesia leads to vasodilatation and improves tissue perfusion. Postoperative pain relief and sympathetic blockage are additional benefits of epidural anesthesia. The purpose of this study was to determine whether epidural ...

The aim of this research is to determine: the influence of continuous opiate and intermittent non-opiate postoperative analgesia on thoracic surgical patients' acute phase response, based on acute phase response protein serum values (IL-6 and C-reactive protein) 24, 48 and 72 hours aftersurgery; to analyze the acute phase responses in ...

BACKGROUND AND OBJECTIVE: Preincisional and postoperative transcutaneous electrical nerve stimulation (TENS) administration reduces postoperative opioid demand in abdominal surgery. Aim of this study was to find out whether a comparable effect of TENS applies in major spinal surgery. METHODS: Thirty-eight patients of both sex scheduled for lumbar interbody fusion were ...

Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. A randomized double-blind study was performed in Hospital São Paulo. During the postoperative period, in the presence of pain, 29 ...

BACKGROUND: In a randomized, double-blind, prospective study, we have evaluated the effect of i.v. infusion of magnesium sulphate during spinal anaesthesia on postoperative analgesia and postoperative analgesic requirements. METHODS: Forty patients undergoing total hip replacement arthroplasty under spinal anaesthesia were included. After the induction of spinal anaesthesia, the magnesium group ...

BACKGROUND: This experimental study was designed to investigate and compare the effects of different anesthesia techniques on rat cremaster muscle flap microcirculation. METHODS: Fifty male Sprague-Dawley rats (130-150 g body weight) were divided into five experimental groups containing ten animals each. Group I, group II, and group III were designated ...

OBJECTIVES: Continuous epidural analgesia may be considered in liver resection but is often avoided because of possible coagulopathies and the risk of epidural hematoma in the postoperative period. On the other hand, there is no coagulation defect during the surgery. Effective prevention of postoperative pain may require continuous sensory ablation ...

BACKGROUND AND OBJECTIVE: Our objective was to report on the design and essentials of the Etoricoxib protocol- Preemptive and Postoperative Analgesia (EPPA) Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy. DESIGN AND METHODS: The study is a ...

We sought to determine the potential of remote ischemic periconditioning (RIPC), and its combination with morphine, to reduce reperfusion injury in primary percutaneous coronary interventions. Remote ischemic post-conditioning is implemented by applying cycles of ischemia and reperfusion on a remote organ, which result in release of circulating factors inducing the ...

Over 500,000 total knee arthroplasties (TKAs) are performed annually in the US, yet postoperative pain management varies widely. In patients managed with epidural analgesia, the epidural catheter is generally removed on the second postoperative day. We compared in-hospital outcomes associated with removing the epidural catheter on postoperative day 1 (POD1-group) ...

Patient-controlled analgesia is a widely used and effective method of controlling pain after THA. This method is associated with substantial undesirable side effects. Local infiltration has been introduced in an attempt to reduce opioid requirements postoperatively, but its ability to reduce pain without complications is still questioned. We evaluated patient-controlled ...

An extended-release epidural morphine (EREM) has been introduced to improve postoperative pain management. Studies have shown the effectiveness of this agent in providing better pain control and patient satisfaction for patients undergoing total joint arthroplasty. We evaluated postoperative pain relief by comparing average daily pain scores and opioid use with ...

BACKGROUND: Randomized trials comparing air to saline for loss of resistance (LOR) for identification of the epidural space have suggested the superiority of saline. We hypothesized that, in actual clinical practice, anesthesiologists using their preferred technique would produce similar analgesic outcomes with either air or saline. METHODS: The labor analgesia ...

Fast-tracking implies a preoperative patient care paradigm that reduces time to recovery and discharge. The current study adopted fast-track anesthetic techniques, comparing outcome of a multimodal non-opioid and another opioid regimen, on recovery profiles after colonic surgery, with standard anesthetic practice. Seventy five ASA II colectomy patients were randomly assigned ...

PURPOSE: We report our experience of paravertebral block (PVB) on analgesic requirements and dynamic pain in patients presenting for hand-assisted laparoscopic nephrectomy (HALN) and compare our results with conventional opioid therapy. PATIENTS AND METHODS: From October 2006 to May 2008, 30 patients (male:female ratio, 17:13) scheduled for HALN received paravertebral ...

Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of ...

BACKGROUND: Epidural analgesia is widely used for efficient pain relief after major surgery. However, it may cause urinary retention, leading to delayed removal of bladder catheters with prolonged patient discomfort. Using a specific regimen in patient controlled epidural analgesia (PCEA), we examined the optimal duration of urinary catheterization in patients ...

In the attempt to reduce postoperative complications and costs and improve outcomes, the concept of fast track surgery has been proposed. Improvements in anesthesia techniques and a better understanding of the pathophysiologic events occurring during and after surgery have made it possible. A group of patients undergoing colorectal resections with ...

BACKGROUND: The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. METHODS: The MEDLINE, EMBASE, and Cochrane databases were searched for prospective, randomized studies comparing air versus liquid ...

A case of postoperative epidural hematoma with an atypical presentation and an excellent outcome in an 80 year-old woman who received both prophylactic aspirin and enoxaparin following a primary total knee arthroplasty, is presented. She developed lower limb neurological symptoms, fully recovered, and then deteriorated again. The hematoma was surgically ...

PURPOSE: The aim of this observational study was to assess the influence of preoperative opioid consumption on postoperative morphine consumption after leg amputation performed under combined regional and general anesthesia. METHODS: After Institutional Review Board approval, patients scheduled for leg amputation were included in a prospective observational study. A popliteal ...

INTRODUCTION: A prospective audit of neonates, infants, and children receiving opioid infusion techniques managed by pediatric acute pain teams from across the United Kingdom and Eire was undertaken over a period of 17 months. The aim was to determine the incidence, nature, and severity of serious clinical incidents (SCIs) associated ...

OBJECTIVE: Our aim was to study local synovial metabolism, inflammation, and subjective pain scoring after intra-articular injection of morphine, ketorolac, or placebo in knee arthroscopy. METHODS: Sixty patients undergoing knee arthroscopy were randomized into 3 groups receiving morphine, ketorolac, or placebo before surgery. Microdialysis of the synovial membrane was performed ...

BACKGROUND: Standard base excess (SBE) is an important parameter for guiding fluid management in postoperative metabolic acidosis. However, individual SBE components, notably the chloride effect (Cl(eff)), provide valuable additional information. Cl(eff) is the deviation of the strong ion difference (SID) from normal caused by chloride loss or increase and represents ...

Eighty patients with osteoarthritis who underwent unilateral total knee arthroplasty were randomly assigned to two groups: the trial group received an intra-operative intra-articular injection of magnesium sulphate and ropivacaine, and the control group received an injection of normal saline. All patients received patient-controlled analgesia with morphine for 48 h post-operatively. ...

BACKGROUND: Commonly used sedatives/analgesics can increase the risk of postoperative complications, including delirium. This double-blinded study assessed the neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine compared with morphine-based regimen after cardiac surgery at equivalent levels of sedation and analgesia. METHODS: A total of 306 patients at least 60 yr old ...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients undergoing thoracic surgery is paravertebral block (PVB) as effective as epidural analgesia for pain management? Altogether >184 papers were found using the reported search, seven of which represented the best ...

Surgical correction of pectus excavatum (PE) is primarily performed to achieve cosmetic and psychological benefits for the patient. Minimally invasive repair of PE is often associated with severe postoperative pain. This study estimates the effect of the severity of PE on the postoperative consumption of opioid analgesics following this procedure ...

BACKGROUND: The optimal timing of epidural analgesia has been a controversial issue, and how early women can benefit from epidural analgesia is still debated. The objective of this trial was to test the hypothesis that patient-controlled epidural analgesia given at cervical dilation of 1.0 cm or more does not increase ...

BACKGROUND: In 2006, the authors observed a cluster of three deaths, which circumstances suggested were opioid-related, within 1 day after placement of intrathecal opioid pumps for noncancer pain. Further investigation suggested that mortality among such patients was higher than previously appreciated. The authors performed investigations to quantify that mortality and ...

OBJECTIVE: We compared the effectiveness of continuous transcutaneous electrical nerve stimulation (TENS) and intermittent TENS in the management of pain after coronary artery bypass grafting (CABG). METHODS: We randomized 100 patients who had undergone median sternotomy for CABG into 4 groups with 25 patients each: (1) continuous TENS (CTENS) and ...

AIM: Epidural fibrosis following a laminectomy procedure is a serious problem that results in failed back surgery syndrome. Aserious number of manuscripts have explained its possible mechanism and results but no effective preventive surgical technique or treatment is currently present. MATERIAL AND METHODS: We used a rat hemilaminectomy model at ...

OBJECTIVE: To compare the efficacy between combined spinal-epidural block and general anesthesia in patients undergoing percutaneous nephrolithotripsy (PNL). METHODS: A total of 180 patients undergoing PNL were randomly allocated to receive spinal-epidural anesthesia plus intravenous patient-controlled anesthesia with tramadol or general anesthesia (propofol induction, maintenance with sevoflurane) plus intravenous patient-controlled ...

In a retrospective, non-randomized, observational study, we compared methods of postoperative analgesia in 5212 cases treated in 2003 and 2004. Patients were allocated to two groups: Group A included 2,796 patients treated in 2004; Group B included 2,419 treated in 2003.The acute pain team was staffed by anaesthesiologists who performed ...

PURPOSE: Several sustained-release morphine (SRM) formulations are available internationally. This study compared 2 such products available in the United States, SR1 and SR2.Patients and METHODS: In an open-label study, patients with advanced cancer pain were randomized to receive SR1 or SR2 every 12 hours around-the-clock (ATC) for 5 days, with ...

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: ...

Anterior cruciate ligament reconstruction (ACLR) has the potential for significant post-operative pain. Conventional systemic opiate treatment may cause nausea and drowsiness, which may delay recovery. The use of intra-articular local anaesthesia has been shown to be effective. We wished to examine the additional effect of intra-articular morphine. This is a ...

STUDY OBJECTIVE: To examine the influence of abdominal colectomy with combined general anesthesia and epidural analgesia versus general anesthesia on apoptosis of circulating lymphocytes. DESIGN: Prospective, randomized, clinical comparison study. SETTING: Tertiary-care general hospital. PATIENTS: 40 ASA physical status I and II patients undergoing elective open colectomy for nonmetastatic colon ...