Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2012
Randomized Controlled TrialSingle-injection femoral nerve block lacks preemptive effect on postoperative pain and morphine consumption in total knee arthroplasty.
Postoperative pain is severe after total knee arthroplasty (TKA). Therefore, femoral nerve block (FNB) is commonly used as an adjuvant to spinal anesthesia for TKA. Some anesthesia providers perform this preoperatively, while others perform it postoperatively. To our knowledge, no study has compared the relative benefits of the timing of performing the procedure. In this study, we investigated whether preoperative FNB would provide better analgesic effects than postoperative FNB in patients undergoing unilateral TKA. ⋯ Patients who received FNB used for total knee arthroplasty consumed significantly less postoperative morphine and had significant relief of post-TKA pain on postoperative day 1 than those who did not have FNB. However, at follow-up we found no significant differences in these values between those receiving FNB before surgery and those receiving it after surgery.
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Acta Anaesthesiol Taiwan · Jun 2012
ReviewPossible interventional therapies in severe sepsis or septic shock.
For many years, basic research with relatively straightforward pathophysiologic approaches has driven clinical trials using molecules that supposedly interfere positively with inflammatory processes. However, most of these trials have failed to demonstrate any outcome benefit. Indeed, we need to revisit current paradigms and to think about the possibility that outcome may be predetermined in severe sepsis or septic shock. ⋯ Fortunately, ongoing research continues to provide new information on the management of sepsis, in particular, severe sepsis or septic shock. High quality and effective management tools are necessary to bring evidence-based therapy to the bedside. On this basis, new therapies could be tested to reduce mortality rates with respect to recently published studies.
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Acta Anaesthesiol Taiwan · Jun 2012
Case ReportsTreating a patient with intractable paralytic ileus using thoracic epidural analgesia.
Postoperative ileus is considered an undesirable response to major abdominal surgery that leads to discomfort, complications, morbidity, and the prolongation of hospital stays. Although thoracic epidural analgesia has been introduced to prevent and/or reduce postoperative ileus, it is rarely used as a way to treat postoperative ileus. A 65-year-old man developed paralytic ileus after undergoing a colectomy. ⋯ With this treatment, daily drainage from a nasogastric tube was gradually decreased and flatus was noted. A week later, the patient could start receiving a liquid diet. Therefore, thoracic epidural analgesia can be used to treat or alleviate paralytic ileus.
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Acta Anaesthesiol Taiwan · Jun 2012
Case ReportsSpinal cord injury: a rare complication following thoracic epidural anesthesia for percutaneous nephrolithotomy.
Herein, we report a rare instance of paraplegia following percutaneous nephrolithotomy under thoracic epidural anesthesia in a conscious patient. The possible factors include low body mass index, chronic renal failure, and multiple "in and out" needle passes during the procedure. ⋯ This not only delayed the recognition of the disorder, but also delayed treatment, consequently resulting in permanent paraplegia. Careful monitoring after epidural blocking should be undertaken in order to allow the early detection of mismanagement and limit the extent of neurologic injury.
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Acta Anaesthesiol Taiwan · Jun 2012
Randomized Controlled TrialAnalgesic efficacy of tramadol/acetaminophen and propoxyphene/acetaminophen for relief of postoperative wound pain.
Weak opioid combined with acetaminophen (APAP) has been proven to provide better analgesic efficacy and cause fewer complications than either drug alone. However, there are questions about whether different opioids, tramadol and propoxyphene, provide similar efficacy or safety. Thus, we investigated Ultracet (37.5 mg tramadol/325 mg APAP) and Depain-X (65 mg propoxyphene/650 mg APAP). The primary aims of this study were to compare the analgesic efficacy and adverse effects of single-dose oral Ultracet versus Depain-X in acute postoperative pain. ⋯ Among patients with mild to moderate postoperative wound pain, single-dose Ultracet can provide slightly better analgesic efficacy than Depain-X in terms of onset and duration. Depain-X is no longer marketed in Europe, America, Taiwan and other countries, therefore, Ultracet can serve as a good substitute for treating postoperative pain.