Deksametazon- intratekalni reducens jednostavnih hematoloških biomarkera stresa

Proximal femoral fractures are the most common cause of emergency admission to hospital with high postoperative morbidity. The hypothesis was that a single shot of intrathecal dexamethasone and levobupivacaine in anaesthesia for surgical correction of proximal femoral fracture in elderly patients reduces surgical stress with better quality hospitalisation. The study included sixty elderly patients with proximal femoral fracture, ASA status 2 and 3, randomised into two groups. The study group of thirty patients received 8 mg of dexamethasone and 12,5 mg of levobupivacaine 0,5 % intrathecally, DLSA group, and the parallel group of thirty patients received 12,5 mg of levobupivacaine 0,5 % intrathecally, LSA group. Plasma cortisol and glucose concentrations were assessed before and after anaesthesia, pain intensity was evaluated using Visual Analogue Scale score and hospitalisation was analysed. Results showed decreased cortisol concentrations, longer analgesia duration and shorter hospitalisation in the DLSA group. Glucose concentrations did not differ significantly between the patients in either group. Enlightening the study results collected, single shot of intrathecal administration of dexamethasone in spinal anaesthesia for surgical treatment of proximal femoral fractures reduces the stress response by decreasing plasma cortisol concentrations prolonging analgesia with better rehabilitation possibilities, hence shortening hospitalisation which explains this pattern of anaesthesia.Proksimalni prijelomi bedrene kosti su najčešći uzrok prijma u bolnicu s visokim poslijeoperacijskim morbiditetom. Hipoteza je da jedna intratekalna doza deksametazona s levobupivakainom za kiruršku korekciju prijeloma proksimalnog dijela bedrene kosti smanjuje kirurški stres sa kvalitetnijim boravkom u bolnici. U istraživanje je bilo uključeno šezdeset pacijenata starije dobi s prijelomom proksimalnog dijela bedrene kosti, ASA status 2 i 3, te su bili randomizirani u dvije skupine. Trideset pacijenata je primilo 8 mg deksametazona i 12,5 mg 0,5 % levobupivakaina intratekalno, DLSA skupina, trideset pacijenata u usporednoj skupini je primilo 12,5 mg 0,5 % levobupivakaina intratekalno, LSA skupina; tijekom anestezije za kiruršku korekciju. Plazmatske koncentracije kortizola i glukoze mjerene su prije i poslije kirurškog zahvata, intenzitet boli je određivan zbrojem VAS, te je analizirano trajanje hospitalizacije. Rezultati istraživanja su prikazali smanjene koncentracije kortizola, dulje trajanje analgezije te kraće trajanje hospitalizacije u DLSA skupini u usporedbi sa LSA skupinom. Koncentracije serumske glukoze nisu se značajnije razlikovale između skupina. Rasvjetljavanjem skupljenih rezultata, jedna intratekalna injekcija deksametazona u spinalnoj anesteziji za kiruršku korekciju prijeloma proksimalnog dijela bedrene kosti snižava stresni odgovor smanjenjem plazmatske koncentracije kortizola s duljim analgetskim učinkom te boljim mogućnostima rehabilitacije, skraćujući time hospitalizaciju što opravdava ovaj anesteziološki obrazac kao metodu izbora

Regional anaesthesia and chronic renal disease

Chronic kidney disease (CKD) has become increasingly prevalent in our aging patient population, especially because glomerular filtration rate (GFR) and renal reserve decline progressively as we grow older. The most common causes of CKD are diabetes mellitus, hypertension and glomerulonephritis. The aim of this article is to present different regional techniques relevant to patients with CRF. We also reviewed possible complications and specificities that should be addressed when administering regional anesthesia

Učinak lokalne infiltracijske anestezije na liječenje poslijeoperacijske boli kod rinoplastike u dnevnoj kirurgiji

Use of local infiltration anaesthesia with 2% lidocaine in combination with epinephrine 1/100000 in rhinoplasty and 0.25% levobupivacaine in this research as an adjunct to general anaesthesia is compared analysing the need for postoperative analgesia in rhinoplasty patients. 30 patients received lidocaine combined with epinephrine (LA) and other 30 patients received levobupivacaine (LB). Comparison is done with Visual Analogue Scale in 30 min and 1, 3, 6 h postoperatively. Also 24 h need for analgesic treatment was recorded. In conclusion postoperative analgesia in LB group with general anaesthesia was significantly prolonged (P = 0.038).Preoperativnu lokalnu infiltracijsku anesteziju sa 2% lidokainom u kombinaciji sa epinefrinom 1/100000 i 0,25 % levobupivakainom kao dodatku općoj anesteziji uspoređivali smo mjerenjem potrebe za postoperativnom analgezijom u pacijenata koji su se podvrgli operativnom zahvatu korekcije nosa. 30 pacijenata je primilo lidokain u kombinaciji sa epinefrinom (LA), a drugih 30 pacijenata je primilo levobupivakain (LB). PremaVisualnoj analgnoj skali s (VAS) mjerena je razina boli nakon 30 min, 1, 3, 6 sati. Isto tako unutar 24 sata mjerena je potreba za analgetskom terapijom. Poslijeoperacijska analgezija je trajala značajno dulje u skupini pacijenata LB u kojoj je primijenjen levobupivakain u kombinaciji sa općom anestezijom (P = 0.038)

Utjecaj primjene deksametazona u spinalnoj anesteziji kod prijeloma bedrene kosti [Influence of dexamethasone administration in spinal anesthesia for femur fracture]

Proximal femur fractures are the most common cause of emergency admission to hospital with high postoperative morbidity. The hypothesis is that one single shot of dexamethasone with levobupivacaine in spinal anesthesia reduces postoperative pain and cognitive disturbances. The study included 60 patients with proximal femur fracture, ASA status 2 and 3 who were randomized into two groups. DLSA group received 8 mg of dexamethasone and 12.5 mg of 0.5% levobupivacaine intrathecally. LSA group received only levobupivacaine. The postoperative cognitive disturbance was evaluated with CAM-ICU score scale, the pain intensity was measured with VAS scale and cortisol and glucose samples were taken before and after surgery. Surgical correction was made in 63% of patients in 48 hours after admission. Ephedrine was used in LSA group, P=0,044. We found shorter hospitalization in DLSA group (P=0,045), shorter duration from surgery to discharge (P=0,044), there was lower occurrence of delirium and POCD (P=0,043), longer analgesia (P<0,001) and lower cortisol levels. Regression model in DLSA group showed less occurrence of postoperative cognitive disturbance for 7,67 times. Conclusion: Intrathecal administration of dexamethasone in spinal anesthesia reduces stress response by lowering cortisol levels, pain, occurrence of POCD with better rehabilitation quality and shorter hospitalization without affecting bleeding

Zadovoljstvo rodilja epiduralnom analgezijom tijekom poroda: analiza ankete u jednom bolničkom centru

Epidural analgesia is one of the most common methods of relieving labor pain. The objective of this study was to examine the effectiveness of epidural analgesia, maternal satisfaction and relationship between the effectiveness of epidural analgesia and various factors. Data were analyzed retrospectively and collected during 2022. A total of 60 parturients participated in the study. Data were collected through a questionnaire before the parturient was discharged from the hospital. The mean assessment of pain on a 1–10 numeric rating scale before epidural analgesia was 7.7 and 3.4 after administration of epidural analgesia. The median assessment of pain before epidural analgesia was 8 (7¬¬–8), and the median assessment of pain after epidural analgesia was 3 (2–5). The average satisfaction with epidural analgesia on a 1–10 scale was 8.11, and the median satisfaction was 10 (7–10). Total of 35 (58.3%) parturients rated satisfaction with 10. Statistically significant association between the effectiveness of epidural analgesia and parity, dilution of administered levobupivacaine, fentanyl administration, and level of education was not found. Childbirth pain is significantly alleviated by the application of epidural analgesia and the satisfaction of parturients is very high.Epiduralna analgezija jedna je od najčešćih metoda ublažavanja porodne boli. Cilj ovog istraživanja bio je ispitati učinkovitost epiduralne analgezije, zadovoljstvo rodilja i povezanost između učinkovitosti epiduralne analgezije i pariteta, razrjeđenja primijenjenog levobupivakaina, primijenjenog fentanila te razine obrazovanja. Podatci su analizirani retrospektivno, prikupljeni su tijekom 2022. godine. Ukupno 60 rodilja sudjelovalo je u istraživanju. Podatci su prikupljani pomoću anketnog upitnika prije otpusta rodilje iz rodilišta. Prosječna procjena boli na numeričkoj skali od 1 do 10 prije primjene epiduralne analgezije iznosi 7,7, a nakon primjene epiduralne analgezije 3,4. Medijan procijenjene boli prije primjene epiduralne analgezije iznosi 8 (7 – 8), a nakon primjene epiduralne 3 (2 – 5). Prosječno zadovoljstvo epiduralnom analgezijom na skali od 1 do 10 iznosi 8,11, medijan zadovoljstva je 10 (interkvartilni raspon od 7 do 10). 35 rodilja je zadovoljstvo ocijenilo sa 10, što čini 58,3% uzorka. Statistički značajna povezanost između učinkovitosti epiduralne analgezije i pariteta, razrjeđenja primijenjenog levobupivakaina, primjene fentanila i razine obrazovanja nije pronađena. Porodna bol je značajno umanjena primjenom epiduralne analgezije i zadovoljstvo rodilja je vrlo visoko

Usporedba učinaka i lokalne infiltracijske analgezije u različitih kirurških zahvata u dnevnoj kirurgiji

Purpose of this study was assessing of local infiltration analgesia (LI A) with levobupivacaine on the trend of acute postoperative pain and outcome in individuals who underwent rhinoplasty procedure and abdominoplasty performed in general anaesthesia. The research was conducted on 60 patients, of which 30 patients underwent rhinoplasty procedure and the other 30 patients underwent abdominoplasty procedure in general anaesthesia with LI A in “Bagatin” Polyclinic in the time period between 01.01.2014. and 01.01.2017. Postoperative analgesics doses on the same day of surgery were noted in 85 % of participants who underwent an abdominoplasty procedure and in 45 % of participants underwent rhinoplasty procedure. Patients who underwent abdominoplasty were discharged from the facility within 48 hours, while all patients who underwent rhinoplasty procedure were discharged on the same day of the surgery. During the first postoperative day patients who underwent a rhinoplasty procedure did not require analgesics, while only 3 % of patients who underwent an abdominal liposuction procedure required an additional dose of analgesics. The research results had shown, when LI A was performed, the manifestation of acute postoperative pain and vomiting did not lead to prolonged stay in day surgery.Svrha studije je procjena djelovanja lokalne infiltracijske analgezije (LI A) s levobupivakainom na promjene akutne poslijeoperacijske boli i ishod za pacijente podvrgnute rinoplastici i abdominoplastici u općoj anesteziji. Istraživanje je provedeno na 60 pacijenata, od kojih je 30 pacijenta bilo podvrgnuto abdominoplastici i 30 pacijenata podvrgnuto rinoplastici sa LI A u općoj anesteziji u Poliklinici Bagatin u vremenskom periodu od 01.01.2014. i 01.01.2017. U 85 % bolesnika podvrgnutih abdominoplastici zabilježena je poslijeoperacijska primjena analgetika, te u 45 % bolesnika podvrgnutih rinoplastici. Pacijenti podvrgnuti abdominoplastici otpušteni su iz poliklinike unutar 48 sati nakon kirurškog zahvata, a svi pacijenti koji su podvrgnuti rinoplastici otpušteni su na isti dan kirurškog zahvata. Tijekom prvog poslijeoperacijskog dana bolesnici podvrgnuti rinoplastici nisu imali potreba za analgeticima, dok je u 3 % bolesnika podvrgnutih abdominoplastici bila potrebna dodatna doza analgetika. Rezultati su studije pokazali da uz primjenu LI A-e poslijeoperacijska bol i povraćanje nakon kirurškog zahvata nisu utjecali na duljinu boravka u ustanovi u kojoj je zahvat učinjen

The influence of dexamethasone administration in spinal anesthesia for femur fracture on postoperative cognitive dysfunction

Background and purpose: Cognitive side-effects often complicate postoperative care especially in elderly and fragile patients.The aim of this research is to establish the influence of intrathecal dexamethasone administration in spinal anesthesia with levobupivacaine on postoperative pain, consciousness and values of cortisol levels for patients with femur fracture. Methods: The study is planned as a prospective, interventional, randomized clinical trial. A total of 60 patients ASA2 and ASA3 status, scheduled for surgical procedures will be sorted into two groups and undergo surgery. One group will have spinal anesthesia with levobupivacaine, SA group, and the other study group will have spinal anesthesia with addition of dexamethasone, DSA group. The primary outcome measure is the occurrence of postoperative disturbance of consciousness and plasma cortisol levels. As a secondary outcome measure, we are following pain intensity, blood glucose levels and recovery. Cortisol and glucose are analysed in five measurements. Peripheral venous blood samples are collected before anesthesia, one hour after surgery, third, fifth and on the tenth day after surgery. Postoperative cognitive dysfunction is defined by using Confusion Assessment Method (CAM) criteria. Visual analog scale (VAS) is used to record pain severity among patients. Results: We collected data for 28 patients so far. Preoperative cortisol levels were 713,25nmol/L,pain intensity(VASscore) 8,3. Postoperative cortisol plasma levels in 17 patients in DSA group were significantly lower 384(184-511) nmol/L in comparison to 11 patients in SA group with postoperative cotisol plasma levels 551(397-753) nmol/L. The duration of analgesia in DSA group was 428(350-510) minutes and in SA group 212(183- 254) minutes. According to CAM criteria, postoperative cognitive disturbances were seen in 8 (72%) patients in SA group, and 3 (17%) patients in DSA group. Conclusion: The addition of dexamethasone to the local anesthetic has proven so far that it significantly prolongs the duration of sensory block and, thus, decreases opioid requirements and postoperative cognitive disturbances