British journal of anaesthesia
-
Randomized Controlled Trial
Sugammadex hypersensitivity and underlying mechanisms: a randomised study of healthy non-anaesthetised volunteers.
We investigated potential for hypersensitivity reactions after repeated sugammadex administration and explored the mechanism of hypersensitivity. ⋯ http://www.clinicaltrials.gov NCT00988065; Protocol number P06042.
-
Local anesthetic myotoxicity may be clinically significant, particularly with bupivacaine, at higher LA concentrations and with longer exposure.
pearl -
Review
Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update.
Significant pain can be experienced after laparoscopic cholecystectomy. This systematic review aims to formulate PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations to reduce postoperative pain after laparoscopic cholecystectomy. ⋯ We recommend basic analgesic techniques: paracetamol + NSAID or cyclooxygenase-2 specific inhibitor + surgical site local anaesthetic infiltration. Paracetamol and NSAID should be started before or during operation with dexamethasone (GRADE A). Opioid should be reserved for rescue analgesia only (GRADE B). Gabapentanoids, intraperitoneal local anaesthetic, and transversus abdominis plane blocks are not recommended (GRADE D) unless basic analgesia is not possible. Surgically, we recommend low-pressure pneumoperitoneum, postprocedure saline lavage, and aspiration of pneumoperitoneum (GRADE A). Single-port incision techniques are not recommended to reduce pain (GRADE A).