Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2002
The reduction of preoperative autologous blood donation for primary total hip or knee arthroplasty: the effect on subsequent transfusion rates.
We conducted this quality assurance observational study to examine the effects of a change in policy regarding preoperative autologous blood donation (PABD) and indications for perioperative blood transfusion in patients undergoing primary total hip or knee arthroplasty. Two successive time periods, each including 182 successive patients treated by the same medical team and with standardized anesthesia, were compared. The first study had the following standard transfusion policy: 3 U of PABD collected (n = 119) and liberal autologous transfusion (AT). The second study introduced a specific indication for PABD, on the basis of estimated red blood cell reserve and a life expectancy of more than 10 years; 2 U of PABD was collected (n = 81), and criteria were identical for AT and allogeneic transfusion. We mainly compared the incidence of AT; allogeneic and overall transfusions; the inclusion, admission, and discharge hematocrit values; and the wastage of PABD units. This novel policy increased the number of untransfused patients by a factor of 10 (5.5% vs 56.6%) (P < 0.0001), decreased the number of PABD patients by 30% with a 2.4-fold reduction in AT (30% vs 80%) (P < 0.0001), and did not change allogeneic requirements (13% vs 15%). Although fewer autologous units were collected (172 vs 426), the wastage was higher in Study 2 (46% vs 12%) (P < 0.0001). We conclude that incorporation of patients' individual factors improves the efficiency of transfusion for total hip and total knee arthroplasty surgeries. ⋯ We compared two transfusion policies for primary total hip or knee arthroplasties: first, a standard preoperative autologous donation with a liberal autologous transfusion policy; and second, a more restrictive indication for autologous donation that was based on patients' individual factors, with identical criteria for autologous and allogeneic transfusion. We found that this change of policy reduced autologous donation and transfusion with no increase in allogeneic transfusion.
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Anesthesia and analgesia · Apr 2002
Randomized Controlled Trial Clinical TrialA study of lidocaine iontophoresis for pediatric venipuncture.
In this randomized, double-blinded, placebo-controlled study, we evaluated the safety and efficacy of lidocaine iontophoresis for the prevention of pain associated with venipuncture in 59 children aged 6-17 yr. Children received either lidocaine HCl 2% with epinephrine 1:100,000 (Active) or the same formulation without lidocaine (Placebo) via a 20 mA/min iontophoretic treatment. Pain during venipuncture was assessed by the subject, parent, and nurse using a 100-mm visual analog scale. Median (interquartile range) visual analog scale scores were significantly lower in the Active versus Placebo groups: subject, 7.0 (2.0-20.8) versus 31.0 (12.0-48.0), P < 0.001; nurse, 5.0 (2.2-10.8) versus 24.0 (9.0-47.0), P < 0.001; and parent, 3.0 (0.8-7.2) versus 20.0 (4.5-43.0), P < 0.002, respectively. Similarly, higher median satisfaction scores were given to the Active versus Placebo group by the three evaluators. Of the 59 subjects completing the study, 10 subjects experienced a total of 12 adverse events that were all graded as mild. In conclusion, lidocaine iontophoresis is safe in children, reduces discomfort associated with venipuncture, and increases satisfaction when compared with the placebo. ⋯ In this randomized, double-blinded, placebo-controlled study, we found that dermal anesthesia with lidocaine HCl 2% combined with epinephrine 1:100,000 administered via iontophoresis in children is achieved in 8.8 +/- 2.1 min, reduces discomfort associated with venipuncture, is safe, and increases satisfaction when compared with the placebo.
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Anesthesia and analgesia · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative pain relief in children undergoing tympanomastoid surgery: is a regional block better than opioids?
Peripheral nerve blocks of the surgical site can reduce the need for perioperative opioids thereby decreasing their unwanted adverse effects, such as postoperative nausea and vomiting. In this prospective, randomized, double-blinded study, we examined the efficacy of a great auricular nerve (GAN) block compared with IV morphine sulfate in children undergoing tympanomastoid surgery. After the induction of general anesthesia, children were randomized to receive either a GAN block with 2 mL of 0.25% bupivacaine with epinephrine (1:200,000) and a sham IV injection of 2 mL of saline solution or a sham GAN block with 2 mL of saline solution with an IV injection of 0.1 mg/kg morphine sulfate diluted to 2 mL. Patients' objective pain scores were assessed by a blinded observer and the incidence of vomiting was recorded. The GAN-Block patients as a group required more pain rescue in the postanesthesia care unit; this difference was not statistically different from the IV-morphine group (P = 0.084). Nine GAN-Block patients never received opioid or other analgesics at any time in the first 24 h after surgery. The group that received the GAN block also had a less frequent incidence of vomiting requiring intervention (7 versus 19) during their entire hospitalization or at home (P = 0.027). The GAN-Block group also had more patients who never experienced vomiting (13 of 20 versus 5 of 20, P = 0.026). In this cohort, a peripheral nerve block decreased the overall incidence of postoperative vomiting thereby reducing associated costs. ⋯ We prospectively compared the use of a great auricular nerve block versus IV morphine sulfate in a randomized double-blinded study in children undergoing tympanomastoid surgery. Analgesia was comparable between groups but nearly half the Block group never required additional analgesics and the number of vomiting events was nearly 66% less.