Anesthesia and analgesia
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Anesthesia and analgesia · May 2013
Review Meta AnalysisPreventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs.
Barreveld et al. show that LA administered either IV or via block; before, during or after surgery, significantly reduces postoperative pain and opioid consumption.
Specifically in:
- Total knee arthroplasty (femoral, sciatic and lumbar plexus b., single-shot or continuous)
- Total hip arthroplasty (continuous lumbar plexus; intra-articular LA)
- Knee arthroscopy (single-shot lumbar plexus; IA LA; single-shot femoral nerve ± sciatic).
- Arthroscopic shoulder surgery - interscalene b., single-shot or continuous. IA is not beneficial.
- Hand & forearm surgery - axillary b. offers analgesic benefits only on day of surgery.
- TAP block is beneficial for laparoscopic, open appendectomy, abdominal surgery, cesarean section, and TAH.
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Anesthesia and analgesia · May 2013
Randomized Controlled Trial Multicenter StudyNitrous oxide and serious morbidity and mortality in the POISE trial.
Nitrous oxide exposure was not associated with 30-day MI, stroke, death or hypotension in an observational analysis of POISE subjects.
pearl -
Anesthesia and analgesia · May 2013
Multicenter StudyA multicenter evaluation of a compact, sterile, single-use pressure transducer for central venous catheter placement.
Inadvertent arterial placement of a large-bore catheter during attempted placement of a central venous catheter (CVC) occurs at a rate of 0.1% to 1.0% and may result in hemorrhage, pseudoaneurysm, stroke, or death. Ultrasound guidance or observation of color and pulsatility of blood are not reliable methods for avoiding this serious complication. Measurement of pressure in the needle or short plastic catheter before insertion of the guidewire has been shown to be highly reliable; however, traditional pressure measurement methodology is cumbersome. Recently a compact, sterile, single-use pressure transducer with an integrated digital display has become available. In this study, we evaluated the performance of this new device (Compass® Vascular Access). ⋯ The Compass pressure transducer for CVC placement performed as intended in 298 cases from 4 academic medical centers. There were 5 inadvertent arterial punctures despite the use of ultrasound guidance, all of which were correctly identified by pressure measurement using the Compass. The device was easily used by trainees, and users expressed a positive level of satisfaction.