Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2008
Editorial CommentAnesthesia matters: statistical anomaly or new paradigm?
-
Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialIntraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study.
In this study we assessed the efficacy of intraarticular regional analgesia on postoperative pain and analgesic requirements. ⋯ A combination of intraarticular ropivacaine, morphine, and ketorolac followed by intermittent injections of ropivacaine as needed provided better pain relief, less morphine consumption, and improved patient satisfaction compared with the control group. The group that received IV ketorolac consumed less morphine and was more satisfied with treatment than patients in the control group.
-
Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialEpinephrine 4 microg/mL added to a low-dose mixture of ropivacaine and fentanyl for lumbar epidural analgesia after total knee arthroplasty.
Epinephrine 2 microg/mL added to a local anesthetic-opioid mixture has been found to improve postoperative continuous epidural analgesia at the thoracic (TEA) but not at lumbar (LEA) level. Therefore, we studied whether a higher dose of epinephrine could improve LEA. ⋯ As part of the multimodal pain treatment used, the epidural adjuvant epinephrine 4 microg/mL (12-32 microg/h) did not improve LEA after total knee arthroplasty.
-
Anesthesia and analgesia · Jan 2008
ReviewTactical increases in operating room block time for capacity planning should not be based on utilization.
When a decision has been made to expand operating room (OR) capacity, the choice of surgical subspecialties to receive additional block time and fill the additional OR capacity is a tactical decision. Such decisions are made approximately once a year. Afterwards, typically a few months before the day of surgery, a second stage occurs in which operational decisions allocate OR time and determine the hours of staffing for each specialty based on its expected workload. ⋯ This article reviews the literature on tactical decision-making for expansion of OR capacity. When additional OR capacity is available, it should be planned for those subspecialties that have the greatest contribution margin per OR hour, that have the potential for growth, and that have minimal need for limited resources such as intensive care unit beds. Numerous reasons are presented to explain why tactical planning of additional block time should not be based on current or past utilization of block time.