Allaert, Silvie

Byn, Pieter

Kalmar, Alain

Scharlaeken, Isabelle

Van De Velde, M

Van Overschelde, Philippe

English

Ghent University Academic Bibliography

Volume 32 | e-Supplement 53 | June 2015www.ejanaesthesiology.comEuropean JournalofAnaesthesiologyEuroanaesthesia 2015The European Anaesthesiology Congress ISSN 0265-0215Abstracts ProgrammeBerlin, Germany, May 30 - June 2, 20153 4 66London, United Kingdom, 28 – 30 May 353Acute Pain ManagementResults and discussion: Data from 70 patients were analysed (n=37 in group R, n=33 in group RS). Demographic data were comparable in both groups. Morphine consumption and VAS scores (graph), incidence of side ef fects and satisfaction scores showed no statistically significant dif ference between the groups. There was no significant dif ference in LOHS between group R and RS (6.0 days [3.0-34.0] vs 7.0 days [3.0-34.0] respectively, p=0.21).Conclusion(s): adding sufentanil to ropivacaine does not improve analge-sia when compared to plain ropivacaine in continuous thoracic paravertebral block during 48 hours af ter video-thoracoscopic surgery.References: 1. Katz J., Jackson M., Kavanagh B.P. et al. Clin J Pain.1996; 12:50-52. Burlacu C.L., Frizelle H.P., Moriarty D.C. et al. Anaesthesia 2006; 61:932-7 09AP06-6Local infiltration analgesia (LIA) gives superior analgesia compared to epidural analgesia af ter total knee replacement Scharlaeken I.1, Van Overschelde P. 2, Byn P. 2, Allaert S.1, Van de Velde M.3, Kalmar A.F.11Maria Middelares Hospital, Dept of Anaesthesiology & Intensive Care, Gent, Belgium, 2Maria Middelares Hospital, Dept of Or thopaedics, Gent, Belgium, 3Universit y Hospitals Leuven, Katholieke Universiteit Leuven, Dept of Anaesthesiology, Leuven, BelgiumBackground: Local infiltration analgesia (LIA) is an emerging alternative for patient controlled epidural analgesia (PCEA) for postoperative pain relief af ter total knee replacement. LIA allows faster mobilisation - with beneficial ortho-paedic results-, obviates an urinary catheter, eliminates the risks of epidural catheters, and fastens patient turnover. Conversely, PCEA is considered the gold standard for pain relief in the first days af ter this type of surgery. The aim of this observational study was to evaluate patient perception of the quality of analgesia, postoperative nausea & vomiting, and general comfort.Materials and methods: 81 patients undergoing a total knee replacement between April and July 2015, were asked about pain scores at D0, D2, and D7, PONV, and general comfort. 40 patients received PCEA and 41 patients received LIA (70ml Ropivacaine 2%, ketorolac 30mg and adrenaline 0.4mg). All surgeries were performed using the same surgical technique by two or-thopaedic surgeons, under a standardised general anaesthesia. Spinal an-aesthesia with 2.5 ml levobupivacaine 0.25% was given prior to induction of narcosis, associated with either PCEA (levobupivacaine/sufentanil)for three days, or LIA during surgery, according to the preference of the surgeon. A strict protocol for other analgesic medication (paracetamol, NSAID and trama-dol) was applied in all patients in both groups.Results and discussion: [Box plot of scores. * = significant dif ference]Figure 1 summarizes the results in box-plots. The dots represent the average values.At D0, no significant dif ference in pain scores was reported. Patients in the LIA group reported significantly bet ter pain scores at D2 and D7 and PONV scores. General comfort was not significantly dif ferent (F-test : P=0.054). In addition to significantly bet ter average scores in the LIA group, a remarkably favourable 75th percentile for most questions indicates a much lower incidence of the most extreme discomfort in this group.Conclusion: In addition to faster mobilisation of the patients and elimination of the risks and burden of an epidural catheter and PCEA, LIA delivers equal to bet ter analgesia, and better PONV and general comfort scores. 09AP06-7Ketamine for postoperative analgesia in radical prostatectomy in combination with morphine, tramadol plus electroacupuncture technique or nalbuphine Ntritsou V., Papagiannopoulou P., Vringa M., Stefanoviü D., Kostoglou C., Zachariadou C.‚G. Gennimatas’ General Hospital of Thessaloniki, Dept of Anaesthesiology, Thessaloniki, GreeceBackground and Goal of Study: The aim of this study was to compare the ef ficacy of postoperative analgesia and the incidence of adverse ef fects with intravenous (iv) administration of tramadol plus ketamine in combination with electroacupuncture (EA) technique versus the iv administration of opioids (nalbuphine or morphine) plus ketamine in patients undergoing radical pros-tatectomy (RP).Materials and methods: 105 patients scheduled for RP were randomly as-signed in 3 groups. In Group 1 (n=35) morphine was administered [bolus dose (BD) 0.05mg/Kg and continuous infusion (CI) mg/24h=18-(agex 0.15)], in Group 2 (n=35) tramadol (BD 1.5mg/Kg and CI 0.15mg/Kg/h) with EA tech-nique and in Group 3 (n=35) nalbuphine (BD 0.5mg/kg and CI 0.15mg/kg/h). In all groups ketamine was also administered (BD 10mg and CI 0.15mg/Kg/h). Infusion pumps were designed to provide 24h postoperative pain relief. In Group 2 a certified acupuncturist placed needles into the LI4 point at a 2cm depth in both hands when the closure of the abdominal walls was initiated. EA was applied for 30min using an EA stimulator at a 100Hz frequency and a constant pulse program. EA was administered again at ST36 and LI4 points for 30min at a 4Hz frequency just af ter patient extubation. Pain intensity was evaluated at 6h and 24h postoperatively with Numerical Rating Scale at rest and movement. Rescue analgesia and adverse ef fects were also assessed at 6h and 24h postoperatively.Results and discussion: Demographic data were similar among groups. Patients in group 2 presented statistical significant lower pain scores at rest at 6h and 24h postoperatively compared to group 1 and 3 (p<0.05). At move-ment at 6h and 24h postoperatively group 1 showed statistical significant high-er pain scores compared to group 2 (p<0.05), while there was no significant dif ference between other groups assessments. Analgesic consumption was significantly higher, at 24h in group 3 compared to groups 1 and 2 (p<0.05). No statistical dif ference between groups was noted concerning adverse ef-fects except for bowel movement where Group 2 showed significant faster bowel movement, at all time intervals, compared to group 1 and 3 (p<0.001).Conclusion: In patients undergoing RP, the use of EA technique with the combination of iv administration of tramadol plus ketamine was more ef fective concerning postoperative pain relief and analgesic consumption compared to iv administration of nalbuphine or morphine in combination with ketamine. 09AP06-8Impact of adding ketamine to an opioid in a PCA device for the control of postoperative pain. Systematic review and meta-analyses of randomised-controlled trials Assouline B., Kreienbühl L., Tramèr M.R., Elia N.Geneva Universit y Hospitals, Dept of Anaesthesiology, Geneva, SwitzerlandBackground and Goal of Study: Benefits and risks of adding ketamine to an opioid in a PCA device in the surgical set ting remain unclear. The aim of this systematic review was to examine the impact of ketamine-opioid combina-tions on postoperative analgesia, cumulative opioid usage, and drug-related adverse ef fects.Materials and methods: We searched MEDLINE, Cochrane and EMBASE up until May 2015 for fully published, randomised controlled trials comparing opioid-based intravenous PCA with and without ketamine. Trials in adults or children undergoing surgery with general or regional anaesthesia were eligi-ble. Setup of the PCA pump (bolus, lock-out, background infusion) was not a selection criteria. Included trials had to report on cumulative opioid dose, pain intensity, or opioid or ketamine related adverse ef fects. Trials where patients underwent surgery under sedation only, where ketamine was administered pre- or intraoperatively or via another route than an IV PCA pump, animal stud-ies or abstracts were not considered. Meta-analyses were performed when data were available from at least three studies or at least 100 patients. Results and discussion: We included 18 trials (1209 adults, 104 children). Opioids used were morphine (14 trials), fentanyl (2), tramadol (1), and hydro-morphone (1). Bolus doses of ketamine ranged from 1 to 5 mg. The addition 806050403020103&($/,$3&($/,$3&($/,$3&($/,$3&($/,$3DLQ' 3DLQ' 3DLQ' 3219 &RPIRUW

Local infiltration analgesia (LIA) gives superior analgesia compared to epidural analgesia after total knee replacement

https://biblio.ugent.be/publication/8642305/file/8642306.pdf

Local infiltration analgesia (LIA) gives superior analgesia compared to epidural analgesia after total knee replacement

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