19 research outputs found
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
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
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
Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Properties in Diabetic and Nondiabetic Patients: A Prospective Observational Study.
Purpose Patients with diabetes mellitus (DM) type 2 may have subclinical peripheral nerve neuropathy. We performed this study to compare the differences in duration of axillary brachial plexus blocks in patients with type 2 DM and without DM (NODM). Our hypothesis was that the sensory block duration would be prolonged in patients with DM
Peritonsillar infiltration with levobupivacaine for posttonsillectomy pain relief: does concentration have any effect? A double-blind randomized controlled clinical study
OBJECTIVE: Post-tonsillectomy pain is believed to be mediated by noxious stimulation of C-fiber afferents located in the peritonsillary space, and local anesthetic infiltration to this area may decrease pain by blocking the sensory pathways and thus preventing the nociceptive impulses. We aimed to compare the effects of different concentrations of preincisional peritonsillar levobupivacaine (0.25% and 0.5%) infiltration on postoperative pain and bleeding in a placebo-controlled design