9 research outputs found
Ultrasound-guided transversus abdominis plane block in combination with ilioinguinal-iliohypogastric block in a high risk cardiac patient for inguinal hernia repair: a case report
Background and Purpose: A high risk cardiac patient, ASA IV, was
planned for inguinal hernia repair. Since general anaesthesia presented a
high risk, anaesthesia was conducted with a transversus abdominis plane
(TAP) in combination with ilioinguinal-iliohypogastric (ILIH) block.
Material and Methods: A 70-year old male patient with severe CAD
and previous LAD PTCA, AVR, in situ PPM and severe MR and TR 3+,
was planned for elective inguinal hernia repair. The preoperative ECHO
showed IVS dyskinesis with apicoseptal hypokinesis, global EF 42% and
grade III diastolic dysfunction. The patient also suffered from hypertension,
diabetes mellitus and had severe stenosis of both femoral arteries.
Preoperative preparation included IBP monitoring while the TAP block
was carried out under ultrasound guidance using an 8 Hertz linear probe.
The ilioinguinal and iliohypogastric nerves were identified with ultrasound
and peripheral nerve stimulator. Local anaesthetic [0.5% levobupivacaine
(Chirocaine®, Abbott Laboratories) ] was applied in two locations: in the
upper right fascia of the transversus abdominis muscle (15 ml) and around
the right ilioinguinal and iliohypogastric nerves (10 ml), totalling a volume
of 25 ml. Skin infiltration was performed with 5 ml 2% lidocaine [Lidocaine
®, Belupo] and 5 ml of normal saline.
Results: Sensory block onset was at 28 minutes after administration and
lasted for approximately 18 hours. There were no haemodynamic disturbances and the perioperative course was uneventful.
Conclusion: During the first 18 postoperative hours, the patient was
comfortable and satisfied with the anaesthetic procedure
Short- and long-term outcome of patients aged 65 and over after cardiac surgery
To analyze the short and long-term outcome of patients aged 65 years and over, after cardiac surgery. Over a 12-year period we analyzed 1750 patients with a mean age of 70.09 3.94 years. They were classified into three age groups: between 65 and 69 (n = 709), between 70 and 74 (n = 695) and 75 years and above (n = 346). Follow-up information was obtained by telephone conversation after a 6-month and 3-year period of discharge from the hospital. Included in the follow-up were 1235 patients and an interview was conducted with 501 (40.6%) patients or their next of kin.
Even though the in-hospital morbidity was highest in the oldest age group, there were no significant differences between groups (p = 0.051). There was no significant difference between groups in the length of hospital stay. The greatest in-hospital mortality was noted in the oldest age group (p = 0.046) compared to patients in the age groups between 65 and 69 and between 70 and 74 years old (p = 0.023 and p = 0.036). In the follow-up study, there was a significantly smaller telephone feedback response in the oldest age group compared to the youngest group (p = 0.003). There were no differences between the groups with respect to mortality and cardiac death after the 6-month and 3-year periods of discharge from hospital.
Our data showed that despite a poor short – and long-term outcome in patients aged 75 and over, all patients had an acceptable operative risk
A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone
Aim To test for differences in hemodynamic and analgesic
properties in patients with breast cancer undergoing
quadrantectomy with paravertebral block (PVB) induced
with a solution of either one or two local anesthetics.
Method A prospective, single-center, randomized, double-
blinded, controlled trial was conducted from June
2014 until September 2015. A total of 85 women with
breast cancer were assigned to receive PVB with either
0.5% levobupivacaine (n = 42) or 0.5% levobupivacaine
with 2% lidocaine (n = 43). Hemodynamic variables of interest
included intraoperative stroke volume variation
(SVV), mean arterial pressure, heart rate, cardiac output,
episodes of hypotension, use of crystalloids, and use of inotropes.
Analgesic variables of interest were time to block
onset, duration of analgesia, and postoperative serial pain
assessment using a visual analogue scale.
Results Although the use of 0.5% levobupivacaine with
2% lidocaine solution for PVB decreased the mean timeto-
block onset (14 minutes; P < 0.001), it also caused significantly
higher SVV values over the 60 minutes of monitoring
(mean difference: 4.33; P < 0.001). Furthermore, the
patients who received 0.5% levobupivacaine with 2% lidocaine
experienced shorter mean duration of analgesia
(105 minutes; P = 0.006) and more episodes of hypotension
(17.5%; P = 0.048) and received more intraoperative crystalloids
(mean volume: 550 mL; P < 0.001).
Conclusion The use of 0.5% levobupivacaine in comparison
with 0.5% levobupivacaine with 2% lidocaine solution
for PVB had a longer time-to-block onset, but it also
reduced hemodynamic disturbances and prolonged the
analgesic effect
Effect of clonidine on the cutaneous silent period during spinal anesthesia
Aim: To investigate the effect of clonidine on the cutaneous silent period (CSP) during spinal anesthesia.
----- Methods: A total of 67 adult patients were included in this randomized, prospective, single-center, double-blind trial. They did not have neurological disorders and were scheduled for inguinal hernia repair surgery. This trial was registered on ClinicalTrials.gov (NTC03121261). The patients were randomized into two groups with regards to the intrathecally administered solution: (1) 15 mg of 0.5% levobupivacaine with 50 µg of 0.015% clonidine, or (2) 15 mg of 0.5% levobupivacaine alone. There were 34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group. CSP and its latency were measured four times: prior to the subarachnoid block (SAB), after motor block regression to the 0 level of the Bromage scale, with ongoing sensory blockade, and both 6 and 24 h after SAB.
----- Results: Only data from 30 patients in each group were analyzed. There were no significant differences between the groups investigated preoperatively and after 24 h. The CSP of the L group at the time point when the Bromage scale was 0 was 44.8 ± 8.1 ms, while in the LC group it measured 40.2 ± 3.8 ms (P = 0.007). The latency in the L group at the time point when the Bromage scale was 0 was 130.3 ± 10.2 ms, and in the LC group it was 144.7 ± 8.3 ms (P < 0.001). The CSP of the L group after 6 h was 59.6 ± 9.8 ms, while in the LC group it was 44.5 ± 5.0 ms (P < 0.001). The latency in the L group after 6 h was 110.4 ± 10.6 ms, while in LC group it was 132.3 ± 9.7 ms (P < 0.001).
----- Conclusion: Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone results in a diminished inhibitory tonus and shortened CSP