Nurten Kayacan

Early postoperative pain management after thoracic surgery; pre- and postoperative versus postoperative epidural analgesia: a randomised study

OBJECTIVES Effective analgesia and blockade of the perioperative stress response may improve outcome and epidural analgesia plays a role in the reduction of pulmonary complications following thoracic surgery. In this study, we assessed preoperative and postoperative thoracic epidural analgesia (Preop-TEA and Postop-TEA) techniques on post-thoracotomy pain in 61 patients undergoing posterolateral thoracotomy. METHODS A thoracic epidural catheter was inserted into all the patients before surgery. In Group I, 8 mL of 0.25% bupivacaine plus fentanyl 50 microg in 2 mL was administered preoperatively. In Group II, no medication was administered via the epidural catheter preoperatively and intraoperatively. Postoperative analgesia was maintained with patient-controlled epidural analgesia with bupivacaine and fentanyl solution in both groups. Pain was evaluated at 2, 4, 8, 12, 24 and 48 h at rest and coughing. RESULTS Preop-TEA Group was associated with decreased pain compared with the Postop-TEA Group. CONCLUSIONS In conclusion, preoperative epidural analgesia is an appropriate method for post-thoracotomy pain and is more effective in preventing acute postoperative pain.

The analgesic and sedative effects of intrathecal midazolam in perianal surgery

Background and objective: Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. Methods: Forty-four patients were randomly allocated into two equal groups: Group I (B) received hyperbaric bupivacaine 0.5% 2 mL + saline 0.9% 1 mL in a total volume of 3 mL intrathecally; Group II (BM) received hyperbaric bupivacaine 0.5% 2 mL + 1 mL of 2 mg preservative-free midazolam in a total volume of 3 mL intrathecally. In both groups, the onset and recovery times of sensory block, the degree and recovery times of motor block as well as the sedation and visual analogue pain scores were recorded, and statistically compared. Results: In Group BM, the postoperative visual analogue pain scores were significantly lower at the first 4 h (P < 0.05), the average time until the first dose of additional analgesic requirement was significantly longer (P < 0.05), and sedation scales were significantly higher (P < 0.05), compared to Group B. There were no statistically significant differences in the onset and the full recovery times of sensory and motor blocks in the two groups. Conclusion: The use of intrathecal midazolam combined with intrathecal bupivacaine produces a more effective and longer analgesia with a mild sedative effect in perianal surgery.

Effects of hyperbaric spinal ropivacaine for caesarean section: with or without fentanyl.

Background and objective: Adding various opioids to the local anaesthetic solution administrated intrathecally improves the analgesic potency of spinal analgesia. The purpose of this study was to evaluate the efficacy and safety of intrathecal fentanyl 10 μg added to 15 mg hyperbaric ropivacaine in patients undergoing caesarean section under spinal anaesthesia. Methods: Thirty‐seven healthy, full‐term parturients were randomly assigned into two groups: Group S (saline group, n = 17) received 15 mg hyperbaric ropivacaine in 2.5 mL + 0.5 mL saline; Group F (fentanyl group, n = 20) received 15 mg hyperbaric ropivacaine in 2.5 mL + 10 μg fentanyl in 0.5 mL, intrathecally. Characteristics of spinal block, intraoperative quality of spinal anaesthesia, time to first feeling of pain (complete analgesia), time to first request of analgesics postoperatively (effective analgesia), side‐effects and fetal outcomes were evaluated. Results: Regression of sensory block to L5 was significantly prolonged in the fentanyl group compared with the saline group (P = 0.001). Time to the first feeling of pain (130.6 ± 15.8 min vs. 154.3 ± 31.1 min; P = 0.008) and the first analgesic requirement (161.2 ± 32.6 min vs. 213.0 ± 29.3 min; P < 0.001) were significantly shorter in the saline group compared with the fentanyl group. Side‐effects, umbilical arterial and venous blood gases did not differ between the groups. Apgar scores were similar in both groups and no infants had an Apgar score ≤7 at 5 min. Conclusions: The addition of fentanyl 10 μg, to hyperbaric ropivacaine 15 mg, for spinal anaesthesia increased the duration of analgesia in the early postoperative period in patients undergoing caesarean delivery.

Endothelial Dysfunction in the Human Umbilical Artery due to Preeclampsia Can Be Prevented by Sildenafil

Abstract Objectives. We aimed to determine the effects of sildenafil in human umbilical artery preparation taken from preeclamptic or normal pregnant women, also to investigate underlying mechanisms in these effects. Study design. Eighteen pregnant women with preeclampsia and 18 healthy pregnant women were involved. Relaxation responses of sildenafil in presence and absence of nitric oxide (NO) synthase inhibitor, N-[omega]-nitro-l-arginine methyl ester (l-NAME), and soluble guanylyl cyclase inhibitor, 1H-[1,2,4] oxadiazolo [4,3-a]quinoxalin-1-one (ODQ), were compared between the preeclampsia group and control group. Results. Sildenafil-induced relaxation responses were significantly attenuated in the presence of preeclampsia, l-NAME or ODQ, but not totally abolished. Interestingly, except with ODQ incubation, in all set of experiments maximal relaxation response was achieved by sildenafil. Conclusion. These data indicate that sildenafil might effect vascular responsiveness of human umbilical artery through the involvement of NO/cyclic guanosine monophosphate (cGMP)-dependent and -independent pathways. Further investigations are needed to clarify the exact mechanisms.

Pain Relief for Children after Adenotonsillectomy

Effective pain relief following adenotonsillectomy in children remains a challenge. This study evaluated the effects of intramuscular 0.5 mg/kg ketamine, 1 mg/kg tramadol or 1 mg/kg meperidine on post-operative pain and recovery in 45 children aged 1-7 years undergoing adenotonsillectomy. Anaesthesia was induced with thiopental or sevoflurane (with succinylcholine for intubation) and was maintained with sevoflurane in oxygen and nitrous oxide. Post-operative pain was scored blind using a modified Toddler–Preschooler Post-Operative Pain Scale 30, 60, 120 and 240 min after tracheal extubation. Post-operative agitation scores were also recorded. Mean post-operative pain score was significantly higher in the tramadol-treated group compared with the meperidine-treated group 120 min after extubation. At all other time-points after extubation, mean post-operative pain scores were similar for the three treatment groups. Ketamine was associated with a significantly higher mean agitation score compared with tramadol and meperidine. We conclude that the effects of ketamine, meperidine and tramadol on post-operative pain following adenotonsillectomy in children were similar.

In Vitro Effects of Opioids on Pregnant Uterine Muscle

Opioids are often used for obstetric analgesia. Ideal obstetric analgesia is attained with optimal pain relief and minimal risk for the parturient. Therefore, investigators in the present study explored the effects of different opioids on the myometrium of pregnant rats. Myometrial strips were exposed to increased concentrations of fentanyl (10-8 M to 10-6 M), alfentanil (10-8 M to 10-4 M), remifentanil (10-8 M to 10-4 M), and meperidine (10-8 M to 10-4M). Decreased contractile activity was observed in myometrial strips isolated from pregnant rats at cumulative concentrations of fentanyl, alfentanil, remifentanil, and meperidine. The amplitude of contractions was reduced with increasing concentrations of opioids; this effect was statistically significant at a concentration of 10-4 M. When administered at higher concentrations, opioids may decrease contractions in pregnant rat myometrium.

Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia

BACKGROUND AND OBJECTIVES We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. METHODS One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n=48) received single-shot spinal anesthesia (SSS), group 2 (n=45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. RESULTS Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p<0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p<0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p<0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p<0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p<0.05). The time to first analgesic was significantly longer in group 3 (p<0.05). CONCLUSIONS Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

JUSTIFICATIVA E OBJETIVOS: Avaliamos os efeitos da administracao peridural de levobupivacaina ou solucao salina, extensao do volume peridural (EVE), em bloqueio combinado raqui-peridural (BCRP) para cesariana. METODOS: Foram incluidas no estudo 138 pacientes com gravidez a termo de 37-42 semanas programadas para cesariana. O Grupo 1 (n = 48) recebeu raquianestesia com dose unica (RADU), o Grupo 2 (n = 45) recebeu BCRP-EVE com solucao salina e o Grupo 3 recebeu BCRP-EVE com levobupivacaina. As caracteristicas do bloqueio motor e sensorial os efeitos nas alteracoes hemodinâmicas maternas e nos recem-nascidos foram comparados. RESULTADOS: O tempo para atingir o bloqueio sensorial maximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de regressao do bloqueio sensorio em dois segmentos foi significativamente menor no Grupo 1, enquanto foi significativamente maior no Grupo 3 em relacao ao Grupo 2 (p < 0,05). O tempo de inicio do bloqueio motor foi significativamente maior no Grupo 1 do que nos grupos 2 e 3 (p < 0,05). O tempo para atingir o bloqueio motor maximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de recuperacao do bloqueio motor foi significativamente maior no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo para o primeiro analgesico foi significativamente maior no Grupo 3 (p < 0,05). CONCLUSAO: Bloqueio sensorio-motor rapido e adequado foi obtido em todas as pacientes do presente estudo; no entanto, o bloqueio sensorio-motor teve inicio mais rapidamente, foi mais prolongado e atingiu um novel mais alto nos grupos 2 e 3; esses efeitos foram mais acentuados no Grupo 3.

Comparison of epidural and combined spinal-epidural analgesia in the management of labour without pain.

The effects of combined spinal–epidural analgesia (CSEA) and epidural analgesia (EA) were studied in 50 healthy parturients randomly allocated to receive bupivacaine plus fentanyl either epidurally, or intrathecally and epidurally. Significant differences from baseline values were seen in systolic blood pressure at all time-points except for 4 h in the EA group and at 3 and 4 h in the CSEA group. Significant differences from baseline values were seen in diastolic blood pressure at 1, 2, 3 and 4 h in the EA group, whereas no significant differences from baseline were seen in the CSEA group. Pain scores in both groups were significantly decreased compared with baseline and all scores, except at 2h, were significantly lower in the CSEA group compared with the EA group. The duration of labour and total amount of drugs used were significantly decreased and cervical dilatation was faster with CSEA compared with EA. In conclusion, CSEA was associated with more rapid onset of analgesia and faster progress in cervical dilatation compared with EA, and can be used safely for labour analgesia.

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.