Continous wound infusion versus epidural postoperative analgesia after liver resection in carcinoma patients

Background: Continuous wound infiltration (CWI) and epidural thoracic analgesia (ETA) are analgesic techniques commonly used in the multimodal management of postoperative pain after open abdominal surgery. The aim of this study was to evaluate the effectiveness in pain reduce and postoperative recovery of these techniques in patients scheduled for liver resection. Methods: The retrospective study included 29 patients, with liver resection performed due to metastases of colon carcinoma. The patients were divided into two groups depending on type of postoperative analgesia. Wound catheter group (WC) included patients that had received analgesia through multiorifice wound catheter placed below the fascia and thoracic epidural group (TEA) included that had received local anesthetic through a epidural catheter. Both analgesic regimes were continued for 48 hours postoperatively. All patients received a standard postoperative pain management protocol, including patient-controlled analgesia (PCA) morphine and intravenous diclofenac every 12h. Outcomes measured over 48 h after operation were Numerical Rating Score (NRS) et rest and coughing, morphine consumption, and side-effects (PONV) and time to bowel function recovery. Results and Conclusion: No significant difference in morphine consumption was observed between groups (p=0,395). Pain managment efficacy was satisfactory (NRS <4) in both groups and we did not find significant differences in Numerical rating skale (NRS) between groups (p=0,128). We did not observed statisticaly significant differece in incidence of postoperative nausea and vomiting (PONV).Time to recover the bowel function was significantly reduced in WC Group 85,93 ±21,02 h and in TEA Group 107,64±20,02 h (p=.0,008).We conclude thatwound catheter infusion in liver surgery is simple, safe and even more effective alternative to epidural analgesia in multimodal protocol for postoperative analgesia after liver resection

Continuous wound infusion of levobupivacaine after total abdominal hysterectomy with bilateral salpingo-oophorectomy

Background and Purpose: Blockade of nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a postoperative multimodal pain management after total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO). The role of continuous wound infusion of levobupivacaine for pain relief and postoperative recovery was evaluated. Materials and Methods: Fifty female patients (ASA I-III) scheduled for TAH and BSO were divided in two equal groups during prospective, double-blinded, placebo-controlled trial. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia. Patients were randomly assigned to receive through the catheter 0.25% levobupivacaine (Group L) with 6ml bolus followed by an infusion of 7 ml/h during 48 h, or the same protocol with 0.9% NaCl (Group S). Simultaneously, patient-controlled analgesia provided intravenous morphine. All patients also received diclofenac 75 mg every 12 h for 48 h. Results and Conclusions: Median Visual Analogue Scale (VAS) was satisfactory. Compared with suprafascial saline, levobupivacaine infusion reduced morphine consumption during the first 48 h. The morphine consumption was significantly less (P<0.001) in Group L (6.91 +/– 3.17 mg) in comparison to Group S (50.61 +/– 14.02 mg). Nausea was less in Group L. Time to recover the bowel function was significantly reduced in Group L. No side effects were observed. Postoperative pain control with continuous wound infusion of 0.25% levobupivacaine after TAH with BSO provides effective analgesia, decreases opioid requirements and reduces time to recover the bowel function

Comparation of early continuous epidural and intravenous opioid analgesia on haemodynamic changes after several pelvic fractures

Background and Purpose: Continuous epidural analgesia improves excellent pain control in trauma patients with multiple pelvic fractures. Rezidual haemodynamic instability followed by retroperitoneal hemorrhagie in the first 48 hours often post-pones its application with need for parenteral use of high dose of opioids. The aim was to compere the influence of early continuous epidural and intravenous opioid analgesia on haemodynamic changes in these patients. Materials and Methods: After Ethic Committee approval, fifty trauma patients with isolated multiple pelvic fractures were divided in two equal groups and included in prospective, randomized study. In bought groups initial analgesia was started with sufentanil 10 μg h–1 in the first 24h. After that, in Group EP continuous epidural analgesia (levibupivacain O.125%, 5–7 mL h–1) and in Group O continuous infusion of opioid (sufentanil 5–10 μg h–1) was started. The analgesics dose was titrated following the VAS score under 3. PICCO monitoring was established. MAP, CI, HR, SVRI, ITBVI and ELWI was measured during four days. Statistic analysis was done by SPSS 11.0. Results: Study groups were statistic comparable. In the first 24 hours during continuous opioid anaesthesia, bought groups had high need for fluid replacement (Group EP=3.2 ± 0.3, Group O=3.0 ± 0.5 L/24h) (P=0.0928). Second day, SVRI was lower in O Group (1300–1520; EP Group=1700–1810)(P=0.0243) and recovered with 500–750mLof crystalloids infusion. ITBVI was statistical more stable inGroup EP (950 ± 50; Group O (1100 ± 30)(P=0.0002). Only 10% of patients with low CI (<3.0) in Group EP (Group O=32%) needed catecholamin support. Conclusion: Early continuous epidural analgesia with 0.125% levibupivacain is safe as continuous opioid analgesia in patients with multiple pelvic fractures but without opioids complications and better haemodynamic stability

Life Threatening Complications after Unsuccessful Attempt of the Guidewire Dilating Forceps Tracheostomy in Multi-Trauma Patient with Cervical Spine Injury

Percutaneous tracheostomy (PCT) is a safe method under proper patient selection, increased technical experience and bronchoscopy- or ultrasound-guided procedure. Trauma patients with cervical spine fractures and spinal cord injury are at a high risk for respiratory failure and require a definitive airway followed by prolonged mechanical ventilation. We would like to present multiple, life- threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy (GWDF) in one trauma patient with a cervical spine injury. With this case report we would like to lay emphasis on the importance of continuously bronchoscopy- or ultrasound-guided PTC in trauma patients, especially with cervical spine injury, as the need to respect the steep-learning curve in its performance

Single or double-injection technique in axillary block: the success of motor and sensor blockade

Background and Purpose: Axillary brachial plexus block is the method of choice for surgical procedures of upper arm except shoulder region. Distribution of local anaesthetic toward neurovascular space may be a reason for failed block. We investigated the axillary block effectiveness by singeand double-injection technique. Materials and Methods: Ninety patients (21–81 old; ASA I-IV) scheduled for upper arm surgery were divided in three equal groups during prospective, double-blind study. Nerve position was located with neurostimulator (Stimuplex® HNS 11)(0.5 mA, 2Hz and 0.1 ms). In Group S (single-shot), mixture of 30 mL (15 mL 0.5% bupivacaine and 15 mL 2% lidocaine) was injected only above axillary artery (25 mL around median and 5 mL around musculocutaneus nerve). In Group U and R (double-shot), the same mixture of local anaesthetic was applied above (10 mL around median and 5 mL around musculocutaneus nerve) and below axillary artery (15 mL around radial or ulnar nerve). Motor and sensor block were determined (Bromage scale, Pinprick method). Statistic analysis was done (SSP11.0). Results and Conclusions: Effective block analgesia and anaesthesia was achieved in shorter time in Group R (18+/4 and 26+/–3 min)(Group U: 34+/–4 and 41+/–3 min, Group S: 35+/–4 and 45+/–2 min) (P=0.0000) (Table 2). Block effectiveness was significantly higher after radial nerve stimulation (92%)(Group U 88% and S 76%) (P=0.630). Faster motor block was achieved in Group R (18+/–4)(Group U 26+/–3 and S 35+/–4 min) (P=0.000). Double-shot technique with primar radial nerve stimulation, allows better motor and sensor axillary block in comparison with single-shot technique

Single or double-injection technique in axillary block: the success of motor and sensor blockade

Background and Purpose: Axillary brachial plexus block is the method of choice for surgical procedures of upper arm except shoulder region. Distribution of local anaesthetic toward neurovascular space may be a reason for failed block. We investigated the axillary block effectiveness by singeand double-injection technique. Materials and Methods: Ninety patients (21–81 old; ASA I-IV) scheduled for upper arm surgery were divided in three equal groups during prospective, double-blind study. Nerve position was located with neurostimulator (Stimuplex® HNS 11)(0.5 mA, 2Hz and 0.1 ms). In Group S (single-shot), mixture of 30 mL (15 mL 0.5% bupivacaine and 15 mL 2% lidocaine) was injected only above axillary artery (25 mL around median and 5 mL around musculocutaneus nerve). In Group U and R (double-shot), the same mixture of local anaesthetic was applied above (10 mL around median and 5 mL around musculocutaneus nerve) and below axillary artery (15 mL around radial or ulnar nerve). Motor and sensor block were determined (Bromage scale, Pinprick method). Statistic analysis was done (SSP11.0). Results and Conclusions: Effective block analgesia and anaesthesia was achieved in shorter time in Group R (18+/4 and 26+/–3 min)(Group U: 34+/–4 and 41+/–3 min, Group S: 35+/–4 and 45+/–2 min) (P=0.0000) (Table 2). Block effectiveness was significantly higher after radial nerve stimulation (92%)(Group U 88% and S 76%) (P=0.630). Faster motor block was achieved in Group R (18+/–4)(Group U 26+/–3 and S 35+/–4 min) (P=0.000). Double-shot technique with primar radial nerve stimulation, allows better motor and sensor axillary block in comparison with single-shot technique

Regional anesthesia techniques in cancer pain management

Farmakološko liječenje ostaje glavni terapijski pristup pri liječenju karcinomske boli, a mogu se integrirati i druge strategije tijekom trajanja i liječenja bolesti. Kontrola boli može se postići s pomoću tehnika regionalne anestezije upotrebom trajno implantiranih katetera koji omogućuju prekidanje nociceptivnih putova odgovornih za transmisiju signala boli u središnji živčani sustav. Postavljanje katetera za primjenu analgetika na različitim mjestima u bolesnika s intraktabilnom neuropatskom karcinomskom boli omogućuje odgovarajuću analgeziju i treba biti predloženo prije eventualne primjene destruktivnih tehnika. Cilj je rada prikaz liječenja karcinomske boli s pomoću regionalnih invazivnih tehnika.Pharmacological therapy is the mainstay of treating cancer pain, but other strategies can also be integrated during the course of the disease. Control of pain can be achieved by regional anesthesia techniques using chronically implanted catheters providing interruption of nociceptive pathways responsible for pain transmission to the central nervous system. Placing catheters at different sites for administration of analgesics in patients with intractable (neuropathic) cancer pain provides adequate pain relief and has to be proposed before considering more destructive techniques. The aim of this review article is cancer pain management by using regional invasive techniques

Continuous wound infusion of levobupivacaine after total abdominal hysterectomy with bilateral salpingo-oophorectomy

Background and Purpose: Blockade of nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a postoperative multimodal pain management after total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO). The role of continuous wound infusion of levobupivacaine for pain relief and postoperative recovery was evaluated. Materials and Methods: Fifty female patients (ASA I-III) scheduled for TAH and BSO were divided in two equal groups during prospective, double-blinded, placebo-controlled trial. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia. Patients were randomly assigned to receive through the catheter 0.25% levobupivacaine (Group L) with 6ml bolus followed by an infusion of 7 ml/h during 48 h, or the same protocol with 0.9% NaCl (Group S). Simultaneously, patient-controlled analgesia provided intravenous morphine. All patients also received diclofenac 75 mg every 12 h for 48 h. Results and Conclusions: Median Visual Analogue Scale (VAS) was satisfactory. Compared with suprafascial saline, levobupivacaine infusion reduced morphine consumption during the first 48 h. The morphine consumption was significantly less (P<0.001) in Group L (6.91 +/– 3.17 mg) in comparison to Group S (50.61 +/– 14.02 mg). Nausea was less in Group L. Time to recover the bowel function was significantly reduced in Group L. No side effects were observed. Postoperative pain control with continuous wound infusion of 0.25% levobupivacaine after TAH with BSO provides effective analgesia, decreases opioid requirements and reduces time to recover the bowel function

Life threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy in multi-trauma patient with cervical spine injury [Životno ugrožavajuće komplikacije nakon neuspjela pokušaja perkutane traheotomije kod politraumatizitanog bolesnika s ozljedom vratne kralježnice]

Percutaneous tracheostomy (PCT) is a safe method under proper patient selection, increased technical experience and bronchoscopy- or ultrasound-guided procedure. Trauma patients with cervical spine fractures and spinal cord injury are at a high risk for respiratory failure and require a definitive airway followed by prolonged mechanical ventilation. We would like to present multiple, life- threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy (GWDF) in one trauma patient with a cervical spine injury. With this case report we would like to lay emphasis on the importance of continuously bronchoscopy- or ultrasound-guided PTC in trauma patients, especially with cervical spine injury, as the need to respect the steep-learning curve in its performance

Životno ugrožavajuće komplikacije nakon neuspjela pokušaja perkutane traheotomije kod politraumatizitanog bolesnika s ozljedom vratne kralježnice

Percutaneous tracheostomy (PCT) is a safe method under proper patient selection, increased technical experience and bronchoscopy- or ultrasound-guided procedure. Trauma patients with cervical spine fractures and spinal cord injury are at a high risk for respiratory failure and require a definitive airway followed by prolonged mechanical ventilation. We would like to present multiple, life- threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy (GWDF) in one trauma patient with a cervical spine injury. With this case report we would like to lay emphasis on the importance of continuously bronchoscopy- or ultrasound-guided PTC in trauma patients, especially with cervical spine injury, as the need to respect the steep-learning curve in its performance.Perkutana traheotomija (PTC) je klinički široko prihvaćena metoda osiguravanja dišnog puta u jedinicama intenzivne skrbi. Pravilna selekcija bolesnika prema opće prihvaćenim indikacijama i anatomskim markacijama uz kontinuiranu vizualizaciju postupka bronhoskopom (ili ultrazvukom) osigurava sigurno izvo|enje svakog njegovog segmenta. Sveukupni porast tehničkoga iskustva u izvo|enju PCT neminovno doprinosi smanjenju nastanka mogućih neželjenih komplikacija. Bolesnici sa ozljedom vratne kralježnice, sa ili bez pridružene ozljede vratnoga dijela le|ne moždine čine visokorizičnu skupinu bolesnika sa pojavom produžene respiracijske insuficijencije i potrebom za mehaničkom ventilacijom kod kojih je traheotomija u većini slučajeva neizbježna. Ovim opisom kliničkog slučaja želimo prikazati nastale višestuke, po život opasne komplikacije nakon neuspješnoga pokušaja izvo|enja PCT kod politraumatiziranog bolesnika sa pridruženom povredom vratnog dijela kralježnice. Njime tako|er želimo istaći važnost kontinuirane vizualizacije cjelokupnog postupka izvo|enja PTC (bronhoskopom ili ultrazvukom) kao i poštivanja graduacije stjecanja tehničke i praktične vještine osobe kao i tima koje je izvodi