The effect of epidural administration of dexamethasone on postoperative pain: a randomized controlled study in radical subtotal gastrectomy

BACKGROUND: Epidurally administered dexamethasone may reduce the incidence and severity of postoperative pain. We investigated whether postoperative pain could be alleviated by preoperative or postoperative epidural dexamethasone administration in patients undergoing major abdominal surgery. METHODS: Ninety patients (age 30-77 with American Society of Anesthesiologists physical status I and II) undergoing radical subtotal gastrectomy were randomly allocated to three groups using computer generated randomization. In all groups, 10 ml of 0.25% ropivacaine was injected epidurally before the start and at the end of the operation. In Group I, a bolus ropivacaine epidural without dexamethasone was administered. In Group II, dexamethasone (5 mg) was added to the ropivacaine bolus epidural before the start of operation. In Group III, the same amount of dexamethasone was given with the ropivacaine epidural at the end of operation. Effort and resting VAS, the use of rescue analgesics and any complications noted during the procedure were evaluated. RESULTS: VAS and requirements of rescue analgesics were significantly lower in Groups II and III when compared to Group I. There were no difference in the incidence of nausea and vomiting between groups, but an itching sensation was frequent in Group III. CONCLUSIONS: The administration of 5 mg of dexamethasone epidurallly, before or after operation, could reduce the pain and analgesic requirement after radical subtotal gastrectomy.ope

Optimal sedative dose of propofol to start MRI in children with cerebral palsy

BACKGROUND: This study was designed to determine the optimal sedative dose of propofol to start brain magnetic resonance imaging (MRI) in children with cerebral palsy (CP). METHODS: Twenty children, aged 0.5-5 years, were administered propofol to achieve a University of Michigan Sedation Scale (UMSS) score ≥ 3 in the MRI room. The proper dose of propofol was determined using the up-and-down method. RESULTS: The ED50 and ED95 for successful sedation with a UMSS ≥ 3 were 2.07 mg/kg (95% CI 1.69-2.56) and 2.69 mg/kg (95% CI 2.35-5.59). Respiratory events occurred in 5 patients and were resolved with neck extension, chin lift, or transient respiratory assistance with successful sedation. CONCLUSIONS: Low dose propofol can safely facilitate the initiation of MRI in children with CPope

Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB

BACKGROUND: During transurethral resection of bladder tumors (TURB) under spinal anesthesia, electrical resection of the lateral wall mass may cause violent adductor contraction and possible inadvertent bladder perforation. Therefore, obturator nerve block (ONB) is mandatory after spinal anesthesia to avoid adductor muscle contraction. We compared the success rate and efficacy of an inguinal approach, to a pubic approach for ONB. METHODS: One hundred and two patients who required ONB undergoing TURB with spinal anesthesia were included in this study. After spinal anesthesia, ONB was performed with an inguinal approach (Group I, n = 51) or pubic approach (Group P, n = 51) using a nerve stimulator. In the pubic approach, a needle was inserted at a point 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle. For the inguinal approach, a needle was inserted at the midpoint of the femoral artery and the inner margin of the adductor longus muscle 0.5 cm below the inguinal crease. If the adductor contracture had not occurred by the 3rd attempt, it was defined as a failed block. Puncture frequency, success rate, anatomical characteristics, and the presence of adductor muscle contraction during operation were evaluated. RESULTS: The success rate of ONB was higher in group I compared to group P (96.1% vs. 84.0%, P = 0.046) and the frequency of needle attempts was lower in group I than in group P (1.8 ± 0.9 vs. 1.3 ± 0.6, P = 0.01). CONCLUSIONS: The inguinal approach for ONB appears to be technically easier and offers certain anatomical advantages when compared to the pubic approach.ope

Intrathecal meperidine reduces intraoperative shivering during transurethral prostatectomy in elderly patients

BACKGROUND: Shivering is a frequent event during the perioperative period. We performed a prospective, randomized, double-blind study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for transurethral operations. METHODS: Fifty patients scheduled for elective transurethral resection operations under spinal anesthesia were randomly allocated to two groups. Spinal anesthesia consisted of 0.5% hyperbaric bupivacaine 8 mg and, mperidine (0.2 mg/kg) (meperidine group) or, normal saline (saline group). Data collection, including sensory block level (by pinprick), blood pressure, heart rate, sublingual temperature, incidence and intensity of shivering, pruritus, nausea, and vomiting was performed at 10 minute intervals. RESULTS: The incidence and intensity of shivering was significantly less in the meperidine group than saline group (P = 0.012 and P = 0.008, for incidence and intensity, respectively). However, pruritus was more common in the meperidine group compared with the saline group (16% vs. 0%, P < 0.05). CONCLUSIONS: The addition of meperidine 0.2 mg/kg to intrathecal bupivacaine lowers the incidence and severity of shivering during transurethral prostatectomy in elderly patientsope

Comparison of Remifentanil and Fentanyl for Postoperative Pain Control after Abdominal Hysterectomy

Purpose: In this randomized, double-blind study, we investigated the analgesic efficacy and side effects of continuous constant-dose infusions of remifentanil after total abdominal hysterectomy and compared it to fentanyl. Materials and Methods: Fifty-six adult female patients scheduled for elective total abdominal hysterectomy were enrolled in this study. Patients were randomly assigned to two groups according to fentanyl (group F, n = 28) or remifentanil (group R, n = 28) for postoperative analgesia. Patients in group F were given fentanyl intravenously with an infusion rate of fentanyl 0.5 μg/kg/hr; group R was given remifentanil with an infusion rate of remifentanil 0.05 μg/kg/ min for 2 days. Pain intensity at rest, occurrence of postoperative nausea and vomiting (PONV), dizziness, pruritus, and respiratory depression were assessed 1 hr after arrival at the post-anesthesia care unit, at 6; 12; 24; and 48 hr postoperation and 6 hr post-infusion of the study drug. Pain was evaluated by using visual analogue scale (VAS; 0- 10). The time that patients first requested analgesics was recorded as well as additional analgesics and antiemetics. Results: There were no significant differences in VAS, time to first postoperative analgesics, and additional analgesics between the 2 groups. The incidences and severities of PONV and opioid related side effects were not different between the groups; however, there were 3 episodes (10.7%) of serious respiratory depression in group R. Conclusion: Continuous infusion technique of remifentanil did not reveal any benefits compared to fentanyl. Furthermore, it is not safe for postoperative analgesia in the general ward