N. Boztug

Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study

We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexamethasone, and group LDc received 3 mg/kg lidocaine for IVRA and 8 mg dexamethasone IV to the nonsurgical arm. IVRA was established using 40 mL of a solution. Visual analog scale and verbal pain scores were recorded intraoperatively and for 2 h postoperatively. Postoperative pain was treated with oral acetaminophen 500 mg every 4 h when visual analog scale score was more than 3. Time to request for the first analgesic and the total dose in the first 24 h were noted. Times to onset of complete sensory and motor block were similar in the 3 groups. The times to recovery of motor block (L = 8 [5.91–10.08] min, LD = 13 [6.76–20.19] min, LDc = 6 [4.44–8.43] min) and sensory block (L = 7 [5.21–10.30] min, LD = 12 [6.11–19.40] min and LDc = 6 [4.2–8.11] min) were longer in group LD (P < 0.05). Patients in group LD reported significantly lower pain scores and required less acetaminophen in the first 24 h after surgery. In conclusion, the addition of 8 mg dexamethasone to lidocaine for IVRA in patients undergoing hand surgery improves postoperative analgesia during the first postoperative day.

Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia.

AbstractBackground: To evaluate the clinical efficacy and safety of unilateral spinal anaesthesia with 0.66% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine for arthroscopic knee surgery. Patients and methods: Forty patients with American Society of Anesthesiology physical status grade I–II were randomly and double blindly allocated to one of two groups. Spinal anaesthesia was performed from the L3-4 or L4-5 interspace with the patient in the lateral decubitus position and with the operative side below. Group B (n = 20) received 7.5mg of 0.5% hyperbaric bupivacaine and group R (n = 20) received 10mg of 0.66% hyperbaric ropivacaine. Patients stayed in the lateral decubitus position for 10 minutes and were then turned to the supine position. The characteristics of spinal block, intraoperative quality of spinal anaesthesia, adverse effects and recovery times were recorded. Results: The onset of sensory block and motor block were significantly earlier in group B compared with group R (p < 0.05). The duration of sensory block and motor block were significantly shorter for group R compared with group B (p < 0.05). Bilateral sensory block occurred in 85% of patients in group B and in 40% of patients in group R (p < 0.05). Bilateral motor block occurred in 70% of patients in group B and in 25% of patients in group R (p < 0.05). Conclusion: For outpatient knee arthroscopy, 10mg of 0.66% hyperbaric ropivacaine is preferred to 7.5mg of 0.5% hyperbaric bupivacaine because it provides a more selective unilateral block and a faster recovery.

The effect of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain

Objctive: The present study, investigates the analgesic effects and complications of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain in patients undergoing day case knee arthroscopy. Subjects: Group 1 received 0.5 mg neostigmine, Group 2 received 100 mg tramadol, Group 3 received 20 mg tenoxicam, Group 4 received 20 ml 0.5% bupivacaine (control) in 20 ml normal saline intra-articularly at the end of the surgery. All patients had the same anaesthetic technique. Patients were observed in the recovery room with respect to pain scores, haemodynamic changes and postoperative analgesia at 1, 2 and 4 h postoperatively. Analgesic therapy in the recovery room was managed with 25 mg bolus doses of meperidine when the patients had visual analosue scale (VAS) scores higher than three points. The patients were discharged from hospital with a prescription for diclofenac 75 mg to be used as required. They were asked to complete their pain measures at 24 h and record their analgesic consumption. Results: There were no significant differences among the study groups regarding pain scores, haemodynamic changes, the first analgesic requirement time and complications. All patients in our study had adequate postoperative analgesia without any severe complication. Conclusion: Intra-articular administration of neostigmine, tramadol, tenoxicam or bupivacaine is a simple and effective postoperative analgesic technique after outpatient arthroscopic knee procedures.

Intrathecal Ropivacaine versus Ropivacaine plus Fentanyl for Out-patient Arthroscopic Knee Surgery

We evaluated the effects of low-dose intrathecal ropivacaine with or without fentanyl for arthroscopic knee surgery. Fifty patients were randomized in equal groups to receive an intrathecal solution (3 ml) containing either 10 mg isobaric ropivacaine or 8 mg isobaric ropivacaine plus 25 μg fentanyl. Complete motor blockade occurred in 22 patients (88%) in both groups. The time taken to reach sensory blockade to T10 and total motor blockade was shorter in the ropivacainetreated group, but differences were not statistically significant. The duration of sensory and motor blockade was shorter in the ropivacaine plus fentanyl-treated group. The cephalad spread of sensory blockade was higher with ropivacaine than with ropivacaine plus fentanyl. We conclude that although 25 μg fentanyl added to 8 mg ropivacaine provided shorter motor and sensory blockade durations than 10 mg ropivacaine alone, small doses of ropivacaine plus fentanyl can be used safely for arthroscopic knee surgery.

Effects of use of Thiopental + Mannitol or Etomidate + Mannitol on Cerebral Ischemia During Temporary Occlusion of Middle Cerebral Artery in Intracranial Aneurysm Surgery

Temporary vessel occlusion is an effective technique used by microvascular surgeons to facilitate dissection and permanent clipping of cerebral aneurysms. Prolonged temporary occlusion carries the risk of infarction in the territory distal to the point of occlusion. The risk of infarction can be reduced by reducing the oxygen requirements of the brain and by maintaining collateral circulation by means of blood pressure control. We studied the effects in 90 patients of etomidate + mannitol or thiopental + mannitol usage during temporary clipping in aneurysm surgery on SjVO2. group 1 received thiopental + mannitol and group 2 received etomidate + mannitol for protection before temporary clipping. After normalization of blood pressure (mild hypertension, mean arterial pressure 90-110 mm Hg) a temporary clip was used. Blood samples were taken from the jugular venous bulb catheter to assess SjVO2 at intervals during the procedure. Postoperative radiologic and clinical ischemia were evaluated with a CT scan and neurologic examination. In group 1, 6 patients were given inotropic agent infusion to maintain mean arterial pressure. However, in group 2, the inotropic agent was not required. SjVO2 values increased more than 80% in 1 patient in group 1 and in 2 patients in group 2. A new radiographic stroke was observed in 2 patients in group 2. When etomidate + mannitol was used for protection before temporary clipping, cerebral infaction appeared to be permanent as a result of the prolonged occlusion time. The results of this clinical study need further investigation.