British journal of anaesthesia
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Multicenter Study
A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy.
Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven. ⋯ An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity.
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Randomized Controlled Trial
Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach.
Infraclavicular approach of the subclavian veins is commonly used for central venous access. However, aberrant catheter tip locations are frequently quoted for this approach. It was hypothesized that with the shoulder pulled downwards, the angle between the internal jugular and subclavian veins may increase, directing subclavian catheters into the internal jugular vein. This prospective study assessed the influence of the shoulder position on proper placement of right infraclavicular subclavian catheters. ⋯ The neutral shoulder position minimizes the number of needle passes and the incidence of catheter misplacement during the infraclavicular approach of the right subclavian vein catheterization.
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Randomized Controlled Trial
Additional femoral catheter in combination with popliteal catheter for analgesia after major ankle surgery.
The contribution of the saphenous nerve in pain after major ankle surgery is unknown. The aim of this study was to evaluate its contribution in this context. ⋯ The addition of continuous femoral catheter infusion of ropivacaine to a continuous popliteal catheter infusion improved postoperative analgesia during movement after major ankle surgery. This effect was still present 6 months after surgery.
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Randomized Controlled Trial
Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia.
I.V. lidocaine administration and target-controlled infusion (TCI) of remifentanil may each be used to reduce cough and haemodynamic stimulation during emergence from general anaesthesia. We therefore compared the effects of these two treatments on patients' responses to the tracheal tube during recovery from general anaesthesia after thyroid surgery. ⋯ TCI of remifentanil reduces responsiveness to the tracheal tube during emergence from general anaesthesia more effectively than does i.v. lidocaine in female patients undergoing thyroid surgery.
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Pain management is challenging in intensive care unit (ICU) patients. The analgesic efficacy, tolerance, and haemodynamic effects of nefopam have never been described in critically ill patients. ⋯ A single slow infusion of nefopam is effective in critically ill patients who have moderate pain. The risk of tachycardia and increased cardiac output and also hypotension and decreased systemic vascular resistance should be known to evaluate the benefit/risk ratio of its prescription.