Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty

Purpose The aim of this prospective randomized blinded controlled study was to compare the efficacy of the two local anesthetics, intraarticular bupivacaine and levobupivacaine administration, versus control for postoperative pain control and functional recovery. Length of hospital stay, opioid consumption, and the side effects of opioids were also evaluated. Methods Sixty patients of American Society of Anesthesiologists class I–III undergoing elective knee arthroplasty under spinal anesthesia were randomized into three groups. Groups B (n = 20) and L (n = 20) both received 150 ml solution intraarticularly, containing 200 mg bupivacaine or 200 mg levobupivacaine combined with 0.5 mg epinephrine, respectively, at the end of the surgery. Group C (n = 20) received 150 ml saline intraarticularly. Postoperatively, all groups received injections through the intraarticular catheters in quantities of 120 mg (levobupivacaine for group L, bupivacaine for group B) and 0.5 mg epinephrine whereas group C received a saline bolus at 10 and 22 h. Patients were given tramadol by intravenous patientcontrolled analgesia (PCA), and sodium diclofenac 75 mg intramuscularly was used for rescue analgesic medication. Visual analogue score (VAS) for pain at rest and during mobilization (which was defined as flexion exercise supported by physiotherapist in postoperative first 8 h and afterward a 3-m walk with walker), consumption of tramadol, side effects, and patient satisfaction were recorded until the 48th hour postoperatively. Results Area under the curve values for VAS were lower in groups B and L compared to the control, both at rest and during mobilization (first 48 h) (P = 0.032 and P = 0.029, respectively). Tramadol consumption was lower (P\0.05), patient satisfaction as evaluated with a five-point Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) was higher (P = 0.03), and length of hospital stay was shorter (P = 0.03) in groups B and L compared to group C. Conclusion Intraarticular bupivacaine and levobupivacaine provided better postoperative analgesia both at rest and during mobilization in total knee replacement surgery compared to control. Tramadol consumption and hospital stay were also decreased in the study groups

Transversus abdominis plane block with different bupivacaine concentrations in children undergoing unilateral inguinal hernia repair: A single-blind randomized clinical trial

BACKGROUND: Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. METHODS: After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg RESULTS: Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6 CONCLUSION: TAPB using 1 mg.kg TRIAL REGISTRATION: This trial was retrospectively registered at Clinicaltrals.gov , NCT04202367

Single and double injection paravertebral block comparison in reduction mammaplasty cases: a randomized controlled study

Background This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty. Methods After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3–T4) or double (Group D: T2–T3 & T4–T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3–T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2. Results Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001). Conclusions The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive

Evaluation of Acoustic Reflex Thresholds in COVID-19 Patients With Taste Disorders

Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can result in persistent loss of taste and smell. This study was performed to assess acoustic reflex threshold (ART) in patients with taste disorders caused by SARS-CoV-2. Material and Methods: This retrospective study enrolled 11 patients (9 men, 2 women; average age = 22.3 years) with a history of COVID-19 and had complaints of taste disorder and sensitivity to loud sounds. The control group consisted of 13 healthy participants (10 men, 3 women; average age = 23.4 years). Anamnesis, neuro-otological, ear, nose and throat, and eye examinations, as well as a taste test, pure tone audiometry, speech discrimination test, and impedance audiometry were performed in all participants. Results: All participants in the study group had a negative taste test result. In addition, ART values were significantly higher in the study group than the control group at all frequencies. Conclusions: SARS-CoV-2 could be a neurotropic virus that can cause facial nerve neuropathy

Pre-eclampsia: Factores de riesgo. Estudio en el Hospital Nacional Cayetano Heredia.

Objetivo: El objetivo fue evaluar los factores de riesgo asociados a pre-eclampsia en nuestro hospital. Material y métodos: Se realizó un estudio prospectivo, de tipo caso-control concurrente en 88 pacientes con pre-eclampsia e igual número de controles. El trabajo se llevó a cabo en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia entre los meses de marzo a agosto de 1993. Resultados: Los factores asociados a pre-eclampsia fueron el antecedente previo a pre-eclampsia (OR:17), el índice de masa corporal elevado (OR:9.6), la raza predominantemente blanca (OR:6.4), el antecedente familiar de hipertensión arterial (OR: 5.2), la falta de control pre-natal y la nuliparidad (OR: 2.5). La incidencia de preeclampsia fue 4.11%, y requirieron parto por cesárea el 69.3% de las pacientes. Presentaron complicaciones en el puerperio inmediato 28.4% de los casos, siendo más frecuentes las infecciones

Ultrasound-Guided Continuous Thoracic Paravertebral Block for Outpatient Acute Pain Management of Multilevel Unilateral Rib Fractures

A 61-year-old man with multiple unilateral rib fractures (T3-T8) gained the ability to breathe deeply and to ambulate after ultrasound-guided continuous thoracic paravertebral block and was discharged home after being observed for 15 hours after the block. The ultrasound guidance was helpful in determining the site of rib fractures and the optimal level for catheter placement. This report also discusses the management of analgesia using continuous paravertebral block in an outpatient with trauma. (Anesth Analg 2013;116:255-7

Effective Volume of Ropivacaine 0.75% through a Catheter Required for Interscalene Brachial Plexus Blockade

Background: Ultrasound guidance during peripheral nerve blocks has allowed for reduction in dose and volume of local anesthetic required to accomplish successful blockade using multiple injections through a needle. The authors undertook this study to determine the minimal effective volume required to accomplish successful interscalene brachial plexus block (ISB) through the catheter

Pre-eclampsia: Factores de riesgo. Estudio en el Hospital Nacional Cayetano Heredia.

Objetivo: El objetivo fue evaluar los factores de riesgo asociados a pre-eclampsia en nuestro hospital. Material y métodos: Se realizó un estudio prospectivo, de tipo caso-control concurrente en 88 pacientes con pre-eclampsia e igual número de controles. El trabajo se llevó a cabo en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia entre los meses de marzo a agosto de 1993. Resultados: Los factores asociados a pre-eclampsia fueron el antecedente previo a pre-eclampsia (OR:17), el índice de masa corporal elevado (OR:9.6), la raza predominantemente blanca (OR:6.4), el antecedente familiar de hipertensión arterial (OR: 5.2), la falta de control pre-natal y la nuliparidad (OR: 2.5). La incidencia de pre-eclampsia fue 4.11%, y requirieron parto por cesárea el 69.3% de las pacientes. Presentaron complicaciones en el puerperio inmediato 28.4% de los casos, siendo más frecuentes las infecciones. (Rev Med Hered 1996; 7: 24-31)