Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyPerioperative versus postoperative celecoxib on patient outcomes after major plastic surgery procedures.
Controversy continues to surround the use of cyclooxygenase (COX)-2 inhibitors in the perioperative period. We designed this randomized, double-blind, placebo-controlled study to examine the hypothesis that administration of celecoxib preoperatively or postoperatively and for 3 days after major plastic surgery would improve pain control and clinically important patient outcomes. Another objective of the study was to determine whether perioperative administration of celecoxib offered any advantages over postoperative administration alone. ⋯ Celecoxib (400 mg p.o.) administered on the day of surgery and for 3 days postoperatively is effective in improving postoperative pain management, as well as the speed and quality of recovery after major plastic surgery. However, perioperative administration offers no advantages over simply giving the drug after surgery.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled TrialA prospective randomized double-blind study to determine the effect of thoracic epidural neostigmine on postoperative ileus after abdominal aortic surgery.
Postoperative ileus is a major gastrointestinal complication of abdominal aortic surgery leading to increased rates of morbidity and mortality, longer lengths of hospital stay, and higher costs. In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery. ⋯ Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.
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Anesthesia and analgesia · Mar 2008
Multicenter Study Comparative Study Clinical TrialA simplified approach to vertical infraclavicular brachial plexus blockade using hand-held Doppler.
In this observational study, we used Doppler ultrasound during the performance of vertical infraclavicular brachial plexus blockade. The success rate at inserting the needle at the point where the sound of the subclavian artery via Doppler reached its maximum audibility was compared with that of the classical insertion point. In 89 of the 100 patients, the medial or posterior cord was found at first needle pass. Using the Doppler point for insertion resulted in a significantly more lateral entry point compared with the classical point (P < 0.001) and was associated with a high success rate of infraclavicular block.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyDoes patient-controlled continuous interscalene block improve early functional rehabilitation after open shoulder surgery?
Early mobilization after shoulder surgery plays a vital role in successful functional rehabilitation. However, postoperative pain often reduces, or even prevents, effective physiotherapy. We investigated the effect of analgesia via patient-controlled interscalene technique on early functional rehabilitation after open shoulder surgery. ⋯ Compared with opioid-based PCA, PCISB improved analgesia, but not function, during early rehabilitation of the shoulder joint.
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Anesthesia and analgesia · Mar 2008
Clinical TrialDecision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis.
Guidelines for postoperative nausea and vomiting (PONV) prevention are implemented widely but their effectiveness may be limited by poor adherence. We hypothesized that the use of an electronic decision support (DS) system would significantly improve guideline adherence. ⋯ Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.