Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1997
Aprotinin but not tranexamic acid inhibits cytokine-induced inducible nitric oxide synthase expression.
Cell expression of inducible nitric oxide synthase (iNOS) is increased by cytokines, which results in high endogenous concentrations of nitric oxide (NO) and has been implicated in organ injury, including myocardial reperfusion injury. Serine protease inhibitors reduce cytokine-induced iNOS expression. The protease inhibitors aprotinin and tranexamic acid, which are used to reduce blood loss after cardiac surgery, were evaluated in vitro on cytokine-induced iNOS expression and the resulting NO production to demonstrate the relative antiinflammatory effects of each drug. ⋯ Consistent with the nitrite reduction, aprotinin significantly (P < 0.05) reduced cytokine-induced iNOS expression, while tranexamic acid had no effect. Aprotinin but not tranexamic acid reduces endogenous cytokine-induced NO production by inhibiting iNOS expression. Since increased endogenous NO concentrations secondary to iNOS activation have been implicated in organ injury, aprotinin may have clinical benefits when compared with tranexamic acid.
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Clinical TrialSuprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?
Arthroscopic shoulder surgery has a 45% incidence of severe postoperative pain. Opiates and interscalene nerve blocks have a high incidence of side effects, and intraarticular local anesthetic has been shown to be ineffective when used for postoperative pain relief. The suprascapular nerve supplies 70% of the sensory nerve supply to the shoulder joint, and local anesthetic block of this nerve is effective in certain shoulder pain disorders. ⋯ A 24-h phone call interview revealed a 40% reduction in analgesic consumption and a reduction in verbal pain scores at rest and on abduction. There were no complications from the suprascapular nerve block. This study demonstrates that a suprascapular nerve block for pain relief in arthroscopic shoulder surgery is an effective and safe modality of postoperative pain relief.
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Clinical TrialPostoperative epidural infusion: a randomized, double-blind, dose-finding trial of clonidine in combination with bupivacaine and fentanyl.
The aim of this randomized, double-blind trial of postoperative thoracic epidural analgesic infusions was to determine whether clonidine at 10 microg/h (group C10, n = 22), 15 microg/h (Group C15, n = 24), or 20 microg/h (Group C20, n = 24) improved postoperative analgesia in patients undergoing abdominal gynecologic surgery, without side effects or hemodynamic changes, when added to a 5-mL/h infusion of 0.125% bupivacaine and fentanyl 2 microg/mL (Group CO, n = 22). The 24-h study infusion was supplemented, as required, by patient-controlled epidural fentanyl. Groups were similar for age, weight, duration, and type of surgery. ⋯ Groups were similar for sedation, pruritus, nausea, time to ambulation, and satisfaction with analgesia. Clonidine produced a dose-dependent decrease in blood pressure and pulse rate and an increase in vasopressor requirement (P < 0.01). Epidural clonidine infused at 20 microg/h improves analgesia during coughing when combined with epidural bupivacaine-fentanyl in patients undergoing lower abdominal surgery but is associated with hemodynamic changes and increased vasopressor requirement.