Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Nov 1997
Randomized Controlled Trial Multicenter Study Clinical Trial[The utility of digital infiltration of mepivacaine and ketorolac in postoperative analgesia of the unilateral hallux valgus].
To determine whether locally injected ketorolac provides analgesia additional to that of mepivacaine, and also to prevent, diminish or delay the peripheral hypersensitivity response of postoperative pain. ⋯ Infiltration of 30 mg of ketorolac along with mepivacaine delays the appearance of postoperative pain and diminishes it in the first 24 hours after surgery to correct hallux valgus, in comparison with infiltration of mepivacaine alone plus intravenous ketorolac.
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Rev Esp Anestesiol Reanim · Nov 1997
Randomized Controlled Trial Clinical Trial[Evaluation of the analgesic effectiveness of ketorolac in intravenous regional anesthesia induced by lidocaine].
Intravenous regional anesthesia (i.v.r.) is a safe, effective technique for surgery on the upper extremities, but it provides no postoperative analgesia. The aim of this study was to evaluate the analgesic efficacy of ketorolac during and after surgery with i.v.r. induced by lidocaine. ⋯ No significant differences in the characteristics or hemodynamic parameters analyzed were found between the two groups. Nor did we find any differences in analgesia during surgery. Ten of the 13 patients (77%) in the control group required analgesia within the first two hours, whereas none of the patients in the treatment group required analgesia during that time (p < 0.0001). There were no statistically significant differences between the two groups in the total amount administered altogether, both during and after surgery. No local or systemic side effects were observed.
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We describe a case of prolonged neuromuscular block (longer than 8 hours) after administration of mivacurium. The patient was shown to be homozygous for the atypical butyrylcholinesterase gene. We discuss our treatment of the patient as well as other cases described in the literature, emphasizing the need for neuromuscular monitoring.
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Rocuronium is a new nondepolarizing neuromuscular blocking agent (NDNMBA) that has recently been introduced for clinical use. Its main advantage over other such agents is its rapid onset of action, which may lead to its use as the relaxant of choice when rapid intubation is required. An additional advantage is that, unlike other amino-steroidal NDNMBAs, rocuronium does not produce active metabolites. ⋯ Hemodynamic stability, along with the absence of histamine release even at doses as high as 4 to 5 ED95, allow it to be used in high risk patients. Successful use has been reported in emergency surgery in patients with full stomachs, in cesarean deliveries, in cardiovascular surgery, and in liver, kidney and other transplants. Rocuronium administered in repeated doses or in continuous infusion provides adequate muscle relaxation over the required period, with predictable reversibility of effects.