Minerva anestesiologica
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The rational approach to acute pain management is to use the highest quality evidence available. Acute pain management is more than a collection of interventions. It is a package of care that needs to be examined as a whole as well as in its parts. ⋯ Existing tools can do the job if doctors and nurses are educated, both to dispel the myths and misconceptions and to take responsibility for providing pain control. It is much easier to dispel myths when you have the evidence. In 1846, the first anaesthetic provided pain-free surgery - 150 years later patients should not have to endure unrelieved pain anywhere in the hospital.
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Bupivacaine is a local anaesthetic of great potency and long duration but has also well known cardio-and CNS toxic side-effects. For many years it was nearby the only local anaesthetic with these characteristics, making it applicable to almost all kind of loco-regional anaesthetic techniques, and still nowadays, for economical reasons it is in many occasions the only alternative available. ⋯ According to these analysis we concluded that this drug, though still remaining a good alternative in many fields of loco-regional anaesthesia (like peripheral blocks), as well as an efficient drug equal to the above mentioned ones in any sector like epidural analgesia in caesarean section, its best indication is subarachnoideal anaesthesia (combined and not) where it is the best available drug in hyperbaric solution without doubts. It might be interesting in the next future the comparison with hyperbaric solutions of levobupivacaine (not yet available).
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Ropivacaine is a relatively new long-acting local anesthetic. It is a pure S(-) isomer, with a high pKa and low lipid solubility. Because of its physical and chemical properties, ropivacaine produces a marked differential in sensory and motor blockades, with a toxic potential lower than other long-acting anesthetic solutions. The purpose of this paper was the evaluation of the literature concerning indications and advantages of ropivacaine for different regional anesthesia techniques. ⋯ Ropivacaine is a long-acting local anesthetic with a marked differential blockade between sensory and motor fibres, overall at the low concentrations used for postoperative analgesia. It probably has a slightly lower potency as compared with bupivacaine, but provides similar clinical efficacy in the different fields of regional anesthesia. Ropivacaine is less cardiotoxic and causes less central nervous system toxicity than bupivacaine, and this lower toxic potential has been reported not only with equivalent but also with equipotent concentrations and doses. For this reason, ropivacaine represents a useful alternative to bupivacaine for central and peripheral nerve blocks as well as for the management of postoperative pain relief.
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Minerva anestesiologica · Sep 2001
Review Comparative Study[Spinal or epidural anaesthesia for caesarean section? Compared opinions].
Regional anaesthesia during caesarean section reduces mortality directly related to anaesthesia. Epidural anaesthesia is a good choice when an epidural anaesthesia was performed during labor. General anaesthesia is recommended only for emergency caesarean section and when regional anaesthesia is contraindicated. ⋯ Epidural opiates have a lower incidence of maddening side effects compared with spinal opiates and allow better maternal satisfaction as regard postoperative analgesia. In accordance with ASA guidelines there are no decisive reasons in order to choice spinal or epidural block: actually literature is unable to give a definitive suggestion about complications and advantages. The choice would be take place weighing up maternal wishes, fetal factors (elective versus urgent caesarean section) and the preferences of the anesthesiologist.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Clinical TrialKetorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery.
This study aims to assess the best postoperative analgesia during maxillofacial surgery by using small doses of ketorolac or tramadol or their association and evaluates the presence of adverse effects due to NSAID or opioid use. ⋯ Ketorolac and Tramadol produced comparable, effective and low cost postoperative analgesia during maxillofacial surgery. There are only statistically significant differences considering side effects.