Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialSystemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery.
In this randomized, blinded, placebo-controlled trial, we evaluated whether systemic lidocaine would reduce pain and time to discharge in ambulatory surgery patients. ⋯ Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge.
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Anesthesia and analgesia · Dec 2009
Review Meta AnalysisEpidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance.
The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. ⋯ Larger studies that overcome limitations of heterogeneity across studies and a relatively infrequent occurrence of complications are required to determine the optimal medium for loss of resistance during epidural block.
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Anesthesia and analgesia · Dec 2009
ReviewClinical implications of neuraxial anesthesia in the parturient with scoliosis.
Scoliosis can pose challenges to the initiation and function of neuraxial anesthetics. We reviewed the available literature exploring neuraxial techniques in parturients with uncorrected or corrected (i.e., surgically instrumented) scoliosis. The 22 articles reported 117 attempted neuraxial procedures (uncorrected n = 24 and corrected n = 93). ⋯ Procedures were typically more challenging in corrected patients; 90% of all reported difficulties in this subgroup involved epidural anesthetics. Complications were reported in 3 of 103 patients. We provide suggestions for optimizing efficacy of neuraxial techniques in these patients.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialThe early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study.
Ketamine has been shown to have a morphine-sparing effect soon after surgery. Nevertheless, whether this effect still exists after being combined with nonsteroidal antiinflammatory drugs and acetaminophen, and whether ketamine can decrease chronic pain after nononcologic surgery remain unclear. Thus, we designed a study to assess ketamine's effect on acute and chronic postoperative pain when combined with multimodal analgesia after total hip arthroplasty (THA). ⋯ Ketamine had a morphine-sparing effect after THA, even when morphine was combined with multimodal systemic analgesia. It also facilitated rehabilitation at 1 mo and decreased postoperative chronic pain up to 6 mo after surgery.