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

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)

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

Usporedba hemodinamske funkcije kod dvije vrste lokalne anestezije s vazokonstriktorom u dnevnoj kirurgiji: retrospektivna studija

Abstract - Hemodynamic changes and cardiac arrhythmias are not uncommon in clinical practice, depending on including patient features, surgical treatment and drugs administered. We describe hemodynamic changes developed in young patients, soon after a local infiltration anesthesia in day surgery. Methods - We retrospectively assessed the hemodynamic effect of 2% lidocaine with 0,0125mg/ml adrenaline (Li & AD) administered for septorhinoplasty in 44 participants and combination of 0.5% bupivacaine and 2% lidocaine with 0.0125mg/ml adrenaline (BLi & AD) for breast augmentation in 48 participants. Blood pressure and heart rate were recorded before the introduction of general anesthesia, immediately 5.10 and 20 minutes after administration of local infiltration, anesthetic (LIA) and data were analyzed. Results - The mean systolic blood pressure (SBP) in all observed measurements before general anesthesia (0), immediately, 5 minutes, 10 minutes and 20 minutes after local infiltration anesthesia was higher among patients who underwent septorinoplasty (Li & AD), in relation to patients who underwent breast augmentation (BLi & AD) (p <05). The level of diastolic blood pressure (DBP) in measurement 20 minutes compared to measurement in 10 minutes was increased by 9,52 mmHg. The septorhinoplasty group showed a significant increase in heart rate measured 20 minutes after local infiltration anesthesia with adrenaline. Conclusions - Measured transitory changes in heart rate and blood pressure after local infiltration of vasoconstrictor anesthetics in healthy patients prior to septorinoplasty and breast augmentation may be induced by endogenous and / or exogenous epinephrine. Bupivacaine solution for local infiltration analgesia reduces hemodynamic disturbances and prolongs analgesic effect. We highlight the need for careful preoperative evaluation, including anxiety assessment and treatment in all patients in day surgery.Sažetak Hemodinamske promjene i aritmije srca nisu rijetkost u kliničkoj praksi, ovisne o osobinama bolesnika, kirurškom liječenju i primijenjenim lijekovima. Opisane su hemodinamske promjene koje su se razvile u mlađih bolesnika ubrzo nakon lokalne infiltracije anestezija u dnevnoj kirurgiji Metode Retrospektivno smo procijenili hemodinamski učinak 2% lidokaina s 0,0125 mg/ml adrenalina (Li & AD) primijenjenog za septorinoplastiku u 44 pacijenta i kombinacija od 0,5% bupivakaina i 2% lidokaina s 0,0125 mg/ml adrenalina (BLi & AD) za povećanje dojki u 48 sudionika. Krvni tlak i broj otkucaja srca bilježeni su prije uvoda u opću anesteziju 0, te poslije 5,10 i 20 minuta nakon primjene lokalne infiltracije anestetika (LIA) i podaci su analizirani. Rezultati Srednja vrijednost sistoličkog krvnog tlaka (SRR) u svim promatranim mjerenjima prije opće anestezije (0), odmah 5 minuta, 10 minuta i 20 minuta nakon lokalne infiltracije anestetika bila je viša kod pacijenata podvrgnutih septorinoplastici (Li & AD) u odnosu na pacijentice podvrgnute povećanju dojki, (BLi & AD) skupina (p <05). Vrijednosti dijastoličkog tlaka (DRR) 20 minuta u odnosu na 10 minuta povećane su za 9,52 mmHg(P<0.05). Pacijenti podvrgnuti septorinoplastici imali su značajan porast srčane frekvencije u 20 minuti nakon lokalne infiltracije anestetika s adrenalinom. Zaključci: Izmjerene prolazne promjene otkucaja srca i krvnog tlaka nakon lokalne infiltracije anestetika s vazokonstriktorima u zdravih pacijentica prije septorinoplastike i povećanja grudi mogu biti potaknute endogenim i/ili egzogenim adrenalinom. Bupivakain otopina za lokalnu infiltracijsku analgeziju smanjila je hemodinamske poremećaje i produžila analgetski učinak. Ističemo potrebu za pažljivom preoperativnom evaluacijom, uključujući procjenu anksioznosti i liječenje u svih pacijenata u dnevnoj kirurgiji

A wound infiltration as a method of postoperative analgesia

A wound infiltration is a method of postoperative analgesia efficient in the various surgical subdisciplines. This technique resulted from the observation that patients whose surgical procedures were performed under regional anaesthesia techniques have reduced postoperative analgesic consumption. Owing to the advances in the drug discovery and to the introduction of local anaesthetics with prolonged effects, this technique has less adverse reactions and considerable analgesic effects. New local anaesthetics with long duration of action and low toxicity like levobupivacaine and ropivacaine are currently available at the market. Such drugs with lower potential for systemic toxicity provided additional safety dimension to local infiltration techniques. A variety of methods were developed to achieve painless recovery period, better patient comfort and to improve patient outcome. Probably the most common technique is a field block at the end of the surgery that can be performed both during regional anaesthesia techniques and in the general anaesthesia. The use of wound infiltration techniques was facilitated by important technical improvements in the multilumen catheters and by construction of special drug delivery devices. Numerous disposable elastomeric devices and patient controlled pumps are suitable for prolonged periods of analgesia in the clinical and outpatient setting. Although it can be used alone for less painful procedures, infiltration analgesia is now important part of multimodal pain treatment. This complex approach to the postoperative pain treatment is characterized by the use of different analgesic drugs and techniques, like wound infiltration and intravenous opioid or nonsteroidal anti-inflammatory drugs. Multimodal postoperative pain treatment is acceptable after painful procedures i.e. hip and knee replacement, where it improves pain control and patient outcome

Quality of analgesia with multi-versus two few-hole catheters in patients after colorectal surgery

Background and Purpose: Continuous wound infusionwith local anaesthetics is an effective method in multimodal postoperative pain therapy after colorectal surgery. The choice of optimal type of wound catheter, fewor multi-hole is still controversial. The aim is to evaluate the analgesic potential of these two catheter types. Materials and Methods: Forty patients undergoing colorectal surgery were randomized to intraoperative placement of two epidural catheters (Group EC) or multi-hole catheter (Group WC) in the wound above the fascia. Patients received 0.25% levobupivacaine (Group WC) with 10 mL bolus through the wound catheter followed by an infusion of 6 mL/h during 48 h, or the same protocol with equally divided levobupivacaine doses through two epidural catheters (Group EC). Simultaneously, patient-controlled analgesia provided intravenous morphine. Pain was evaluated postoperatively with 4-point verbal scale (VRS) for the first 2 h, with Visual Analogue Scale at rest (VAS r), and during coughing (VAS c) every 6 h for the first 48 h. Results and Conclusions: No significant difference in morphine consumption was observed between groups. There were no significant differences in VRS scores between the groups (p=0,756). VAS scores were significantly lower in Group WC in rest (rWC, p=0,007) and coughing (cWC, p=0,018) for the 6 h, 12 h, and 24 h postoperatively. In the period 30–48 h there was no difference between groups. We conclude that levobupivacaine infusion through multi-hole catheter provides better quality of postoperative analgesia compared with two epidural catheters for the first 24 h

Trichinella spiralis and Breast Carcinoma – A Case Report

Authors report about a patient with recurrent ductal invasive breast carcinoma and trichinosis. The patient underwent mastectomy of the left breast with evacuation of the axilla because of the cancer. Radiation therapy was received. An infestation with Trichinella spiralis was diagnosed two years after. The patient was treated with mebendazole. A local recurrence of the tumor was found on the chest wall six years after the surgery. Tumor excision was performed. Histological analysis pointed at a ductal invasive carcinoma with numerous parasites of Trichinella spiralis present within both the muscle and the tumor tissue. The finding of parasites in the tumor tissue witnesses in favor of infestation, and the parasite morphology preserved in the tumor shows at the protective effects of the cysts, i.e. preventing parasite necrosis