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https://www.readbyqxmd.com/read/29643621/evaluation-of-dexmedetomidine-and-fentanyl-as-additives-to-ropivacaine-for-epidural-anesthesia-and-postoperative-analgesia
#1
S Kiran, Kavita Jinjil, Urvashi Tandon, Soumita Kar
Background and Aims: The synergism between epidural local anesthetic agent and opioids is well established, but evidence for the combination of local anesthetic agent with dexmedetomidine in epidurals is limited. This study evaluates the clinical efficacy of dexmedetomidine versus fentanyl as an additive to ropivacaine for epidural anesthesia. Material and Methods: Patients undergoing infraumbilical surgeries were divided randomly into three groups - Group R (n = 25): received 18 ml of 0...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29643619/comparison-of-continuous-epidural-infusion-of-0-125-ropivacaine-with-1-%C3%AE-g-ml-fentanyl-versus-0-125-bupivacaine-with-1-%C3%AE-g-ml-fentanyl-for-postoperative-analgesia-in-major-abdominal-surgery
#2
Shruti Shrikant Patil, Amala G Kudalkar, Bharati A Tendolkar
Background and Aim: The present study was carried out to compare the efficacy of continuous epidural infusion of two amide local anesthetics, ropivacaine and bupivacaine with fentanyl for postoperative analgesia in major abdominal surgeries. Material and Methods: A total of 60 patients scheduled for major abdominal surgery were randomized into two study Groups B and R with thirty patients in each group. All patients were administered general anesthesia after placing epidural catheter...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29643618/a-randomized-clinical-trial-of-intrathecal-magnesium-sulfate-versus-midazolam-with-epidural-administration-of-0-75-ropivacaine-for-patients-with-preeclampsia-scheduled-for-elective-cesarean-section
#3
Sophia Paleti, P Krishna Prasad, B Sowbhagya Lakshmi
Background and Aims: Magnesium sulfate and midazolam have been used as adjuvants to local anesthetics via intrathecal and epidural routes to augment the quality of block and prolong postoperative analgesia. This study compares addition of intrathecal magnesium sulfate versus intrathecal midazolam to epidurally administered isobaric ropivacaine as a part of combined spinal epidural technique in pre-eclamptic parturients undergoing elective cesarean section. Material and Methods: After institutional ethics committee approval and written informed consent, 50 pre-eclamptic parturients were randomly allocated to one of the two groups of 25 each to either receive intrathecal magnesium sulfate (50 mg) or intrathecal midazolam (1 mg) in combination with epidural ropivacaine (0...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29643617/comparison-of-ropivacaine-0-2-with-or-without-clonidine-1-%C3%AE-g-kg-for-epidural-labor-analgesia-a-randomized-controlled-study
#4
Indira Kumari, Kapil Sharma, Vikram Bedi, Madhan Mohan, Hemraj Tungaria, Manish Kumar Modi
Background and Aims: The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. Material and Methods: A total of 60 term parturients of the American Society of Anesthesiologists Grade I and II with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labor analgesia after informed consent were divided in two groups...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29629201/anesthesia-and-fast-track-in-video-assisted-thoracic-surgery-vats-from-evidence-to-practice
#5
REVIEW
Marzia Umari, Stefano Falini, Matteo Segat, Michele Zuliani, Marco Crisman, Lucia Comuzzi, Francesco Pagos, Stefano Lovadina, Umberto Lucangelo
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29628682/perioperative-pain-management-following-total-joint-arthroplasty-a-review-and-update-to-an-institutional-pain-protocol
#6
REVIEW
Kimberly L Stevenson, Alexander L Neuwirth, Neil Sheth
As the rate of total joint arthroplasty increases with the aging population of the United States, new focus on decreasing opioid use through the development of multimodal pain regimens (MPRs) is becoming an important area of research. MPRs use different agents and modes of delivery in order to synergistically address pain at many levels of the pain pathway. MPRs include a combination of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, opioids (short- and long-acting), spinal/epidural analgesia, regional nerve blocks, and local anesthetics...
January 2018: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/29628592/magnesium-sulfate-as-a-preemptive-adjuvant-to-levobupivacaine-for-postoperative-analgesia-in-lower-abdominal-and-pelvic-surgeries-under-epidural-anesthesia-randomized-controlled-trial
#7
Heba Omar
Background: Magnesium (Mg) has been evaluated as an adjuvant to local anesthetics for prolongation of postoperative epidural and intrathecal analgesia but not with epidural levobupivacaine in lower abdominal surgeries. Aim of the Study: The aim of the study was to evaluate the preemptive analgesic effect of Mg added to epidural levobupivacaine anesthesia in infraumbilical abdominal surgeries. Settings and Design: This study design was a prospective randomized controlled trial...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628589/clonidine-as-an-adjuvant-to-caudal-epidural-ropivacaine-for-lumbosacral-spine-surgeries
#8
Saraswathi Nagappa, Sandhya Kalappa, Raghavendra Biligiri Sridhara
Background: Caudal epidural analgesia is a proven technique for providing analgesia for spinal surgeries. Prolonged pain relief with no motor blockade is desired for early mobilization. Objective: The objective of this study is to compare the effect of adding 1 μg/kg of clonidine to injection ropivacaine 0.2% with respect to duration of analgesia, hemodynamic effects, and associated side effects. Methodology: In this prospective double-blind study, a total of 60 patients undergoing lumbosacral spine surgery were randomized to receive 25 cc caudal epidural injection of either injection ropivacaine 0...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628571/epidural-volume-extension-with-saline-in-combined-spinal-epidural-anesthesia-for-hip-surgeries-using-low-dose-of-intrathecal-hyperbaric-bupivacaine
#9
Rajiv Singh Bhandari, Rohan Bhatia, Sanjay Agrawal
Background and Aims: The aim of the study was to evaluate the effectiveness of epidural volume extension (EVE) technique in terms of sensory and motor block characteristics along with hemodynamic parameters as a part of combined spinal-epidural anesthesia (CSEA). Materials and Methods: A total of 60 patients undergoing hip surgeries were assigned to one of the two groups containing 30 patients each. Group I (the CSE-EVE group) patients were anesthetized using CSE with EVE and Group II (the CSE group) patients were anesthetized using CSE without EVE, using the same technique and low dose of intrathecal hyperbaric bupivacaine...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628563/postoperative-analgesia-with-epidural-dexmedetomidine-compared-with-clonidine-following-total-abdominal-hysterectomies-a-prospective-double-blind-randomized-trial
#10
Sunil Chiruvella, Balaji Donthu, Srinivasa Rao Nallam, Dora Babu Salla
Background and Aims: Anesthesia for total abdominal hysterectomies is not only concerned with relieving pain during intraoperative period but also during the postoperative period. We compared clonidine and dexmedetomidine as an adjuvant to levobupivacaine for epidural analgesia with respect to onset and duration of sensory block, duration of analgesia, and adverse effects. Materials and Methods: A total of 80 individuals between the age of 45 and 65 years of American Society of Anesthesiologists (ASA) physical status Classes I and II who underwent total abdominal hysterectomies were randomly allocated into two groups, comprising 40 patients in each group...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628556/comparison-of-three-different-concentrations-of-levobupivacaine-for-epidural-labor-analgesia-clinical-effect-and-pharmacokinetic-profile
#11
Ahmed Mostafa El-Shaarawy, Mohamed S Asfour, Doaa A Rashwan, Mahmoud M Amer, Shahira F El-Menshawe, Mohammed H Elkomy
Background: The aim is to compare the clinical effect of three different concentrations of levobupivacaine (0.25%, 0.125%, and 0.0625%) on the sensory and motor block characteristics and mode of delivery during epidural labor analgesia. We also studied the pharmacokinetic profile of the three concentrations during labor. Materials and Methods: Sixty pregnant females undergoing normal vaginal delivery under epidural analgesia were divided into three groups according to the concentration of levobupivacaine used...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628549/comparison-of-efficacy-of-epidural-ropivacaine-versus-bupivacaine-for-postoperative-pain-relief-in-total-knee-replacement-surgeries
#12
Sidharth Bhasin, Mridul Dhar, Deepak Kumar Sreevastava, Rajiv Nair, Saurabh Chandrakar
Background: Epidural analgesia has become the standard of care for knee replacement surgeries worldwide. Bupivacaine has been used successfully for many years. Epidural ropivacaine is now being used increasingly and seems to have benefits other than just pain relief, in terms of a better safety profile. Aim: To compare the efficacy of bupivacaine 0.125% (Group B) versus two concentrations of ropivacaine 0.1% (Group R1) and 0.2% (Group R2), in terms of pain scores, requirement of rescue analgesia, related adverse effects, and duration of postoperative (PO) hospital stay...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29627015/spinal-cord-infarction-clinical-and-imaging-insights-from-the-periprocedural-setting
#13
Nicholas L Zalewski, Alejandro A Rabinstein, Karl N Krecke, Robert D Brown, Eelco F M Wijdicks, Brian G Weinshenker, Derrick A Doolittle, Eoin P Flanagan
OBJECTIVE: Describe the range of procedures associated with spinal cord infarction (SCI) as a complication of a medical/surgical procedure and define clinical and imaging characteristics that could be applied to help diagnose spontaneous SCI, where the diagnosis is often less secure. METHODS: We used an institution-based search tool to identify patients evaluated at Mayo Clinic, Rochester, MN from 1997 to 2016 with a periprocedural SCI. We performed a descriptive analysis of clinical features, MRI and other laboratory findings, and outcome...
May 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29624542/effects-of-combined-lower-thoracic-epidural-general-anesthesia-on-pain-control-in-patients-undergoing-elective-lumbar-spine-surgery-a-randomized-controlled-trial
#14
Marvin Thepsoparn, Jariya Sereeyotin, Patt Pannangpetch
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: Our objective was to compare postoperative pain relief and operating field condition of single shot low thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone. SUMMARY OF BACKGROUND DATA: Prior studies have suggested that continuous epidural analgesia provides better postoperative pain relief and less intraoperative blood loss, but with the risk of the epidural catheter contaminating the surgical field...
April 5, 2018: Spine
https://www.readbyqxmd.com/read/29622010/mechanical-barriers-and-transforming-growth-factor-beta-inhibitor-on-epidural-fibrosis-in-a-rabbit-laminectomy-model
#15
Juan N Albiñana-Cunningham, Purificación Ripalda-Cemboráin, Tania Labiano, José I Echeveste, Froilán Granero-Moltó, Matías Alfonso-Olmos
BACKGROUND: TGF-β has been described as a mediator of fibrosis and scarring. Several studies achieved reduction in experimental scarring through the inhibition of TGF-β. Fibroblasts have been defined as the cell population originating fibrosis, blocking fibroblast invasion may impair epidural fibrosis appearance. For this purpose, biocompatible materials used as mechanical barriers and a TGF-β inhibitor peptide were evaluated in the reduction of epidural fibrosis. METHODS: A L6 laminectomy was performed in 40 New Zealand white rabbits...
April 5, 2018: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/29620988/a-simple-guide-to-regional-anaesthesia
#16
E M Valsamis, S Wade, C Thornhill, C Carey, D Ricketts
Regional anaesthesia is widely used in modern anaesthetic practice for perioperative and postoperative analgesia. In the operating theatre, regional anaesthesia is used both on its own and in combination with other techniques (general anaesthesia and sedation). Regional anaesthesia is now a core skill set in anaesthetic training. This article provides a basic outline of regional anaesthesia for surgeons and other non-anaesthetic staff working with anaesthetists, reviewing preparation, consent, basic and specialist equipment, central neuraxial blocks (spinal, epidural and caudal), trunk blocks, upper limb blocks (interscalene, supraclavicular, infraclavicular and axillary) and lower limb blocks (femoral, fascia iliaca, sciatic, popliteal and ankle)...
April 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29620648/epiduroscopic-laser-neural-decompression-as-a-treatment-for-migrated-lumbar-disc-herniation-case-series
#17
Jinyoung Oh, Daehyun Jo
OBJECTIVE: Epiduroscopic laser neural decompression (ELND) is one of the more invasive techniques for managing patients with herniated lumbar disc. However, ELND can be used to treat, and diagnose the epidural pathology; indications for ELND remain controversial, especially, when applied in cases of large disc extrusion and migrated disc. This paper reports cases of patients that were satisfied with the ELND procedure for migrated lumbar disc herniation. METHODS: We reviewed the medical records of patients that received ELND for migrated lumbar disc in an outpatient clinic...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29587655/impedance-cardiography-as-tool-for-continuous-hemodynamic-monitoring-during-cesarean-section-randomized-prospective-double-blind-study
#18
Alessandro D'Ambrosio, Antonella Cotoia, Renata Beck, Potito Salatto, Lada Zibar, Gilda Cinnella
BACKGROUND: Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia. METHODS: Sixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups...
March 27, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29582422/the-effect-of-spinal-hyperbaric-bupivacaine-fentanyl-or-hyperbaric-bupivacaine-on-uterine-tone-and-fetal-heart-rate-in-labouring-women-a-randomised-controlled-study
#19
A Kuberan, K Jain, R Bagga, J K Makkar
The mechanism for fetal heart rate abnormalities following spinal opioids remains controversial. We evaluated uterine tone, using an intra-uterine pressure catheter, and fetal heart rate abnormalities in 30 women in spontaneous labour with cervical dilation of 3-5 cm having combined spinal-epidural analgesia. Women were randomly assigned to receive a spinal with 2.0 mg hyperbaric bupivacaine plus 15 μg fentanyl, or 2.5 mg hyperbaric bupivacaine. The primary outcome measure was an increase > 10 mmHg in baseline uterine tone in the 30-min period following spinal injection...
March 26, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29576110/haematoma-and-abscess-after-neuraxial-anaesthesia-a-review-of-647-cases
#20
REVIEW
E M E Bos, J Haumann, M de Quelerij, W P Vandertop, C J Kalkman, M W Hollmann, P Lirk
Although rare, spinal haematoma and abscess after central neuraxial blocks may cause severe permanent neurological injury. Optimal treatment and outcome remain unclear. In order to identify possible predisposing patient characteristics and describe the ensuing clinical course, we searched Medline, Embase, and the Cochrane Library for reports of spinal haematomas and abscesses associated with central neuraxial blocks. Extracted data included patient characteristics, symptoms, treatment, and outcome. We analysed 409 reports, including 647 patients (387 patients with spinal haematoma and 260 patients with spinal abscess)...
April 2018: British Journal of Anaesthesia
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