Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 2011
Randomized Controlled TrialThe effect of the addition of lornoxicam (xefocam) intrarticularly on the WOMAC Scale in patients undergoing arthroscopic anterior cruciate ligament reconstruction.
Effective pain relief is important after diagnostic and therapeutic arthroscopic knee surgery to permit early discharge and improve comfort and mobility at home. We compared the intraarticular analgesic effects of ropivacaine and morphine with or without Xefocam and the need for rescue i.v. morphine at rest and during movement in patients undergoing anterior cruciate ligament reconstruction under spinal anesthesia. Anterior cruciate ligament reconstruction (ACLR) is associated with moderate to severe postoperative pain. ⋯ Forty five patients undergoing anterior cruciate ligament reconstruction (ACLR) under spinal anesthesia were enrolled in this study. Patients were divided into three equal groups (15 each); the C group received saline. The RM group received 0.25% ropivacaine and morphine 0.2 mg/mL; the RMX group received 0.25% ropivacaine, morphine 0.2 mg/mL and Xefocam 0.8 mg/mL postoperatively they received intraarticular patient-controlled analgesia. The study drug was given in a volume of 10-mL bolus and a 60-min lockout interval. If needed, rescue morphine 2 mg was self-administered i.v. with 10-min lockout intervals. Pain scores and patient satisfaction were assessed at rest and during movement. There were significant differences among the groups in pain scores and patient satisfaction and in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Classification. Daily morphine consumption was significantly smaller in the RMX group (7 +/- 6 mg) compared with the RM group (23 +/- 20 mg; P = 0.002) and in both groups compared with control (46 +/- 21 mg; P < 0.001). We conclude that intraarticular patient-controlled regional analgesia provides effective pain relief after anterior cruciate ligament reconstruction. The combination of intraarticular ropivacaine, morphine, and xefocam was superior to control or to a combination of ropivacaine and morphine.
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Middle East J Anaesthesiol · Feb 2011
Randomized Controlled TrialPreemptive peritonsillar ketamine infiltration: postoperative analgesic efficacy versus meperidine.
The current study was planned to assess post-tonsillectomy analgesic efficacy of pre-emptive peritonsillar ketamine infiltration with or without bupivacaine in comparison to meperidine alone or in combination with bupivacaine. ⋯ Peritonsillar injection of a combination of bupivacaine and ketamine provided efficient postoperative analgesia after adenotonsillectomy and achieved higher parents' satisfaction for the outcome of surgery. The used drugs' combination and volume could be recommended as a routine preemptive analgesic policy for children assigned for adenotonsillectomy.
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Middle East J Anaesthesiol · Feb 2011
Case ReportsDifficult passage of the endotracheal tube and massive nasal bleeding during awake nasal fiberoptic intubation in a patient with airway obstruction caused by neck hematoma--a case report.
A 60 yr-old male underwent anterior cervical fusion under general anesthesia. Neck swelling was observed at the next morning. Subsequently, emergent CT scanning was performed, which revealed a retropharyngeal hematoma narrowing the upper airway and right anterior neck hematoma significantly deviating the trachea and larynx. ⋯ The patient was submitted to emergent evacuation of the hematoma. Reevaluation of the preoperative CT images showed the nasal cavity narrowing because of widespread nasal mucosal swelling. It is necessary to anticipate that nasal mucosal swelling and bleeding tendency due to impairment of venous drainage can exist in such a case.