AANA journal
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Randomized Controlled Trial Comparative Study
Comparison of fascia iliaca compartment block and 3-in-1 block in adults undergoing knee arthroscopy and meniscal repair.
Peripheral nerve blocks have become a popular method for treatment of pain after lower-extremity surgical procedures. Two peripheral nerve blocks for knee arthroscopy include the 3-in-1 block and the fascia iliaca compartment block (FICB). There is limited research comparing the efficacy of these blocks in adults undergoing knee arthroscopy and meniscal repair who receive both the peripheral nerve block and general anesthesia. ⋯ Patient satisfaction scores were similar between groups. Based on this study we recommend that the choice of block can be determined by the clinical scenario. We recommend a 3-in-1 block if speed of onset is the primary goal of anesthesia before induction, and we recommend the FICB block if prolonged postoperative analgesia is the primary goal.
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The purpose of this study was to determine and compare the maximum concentration (C(max)) and time to maximum concentration (T(max)) of epinephrine administered via tibial intraosseous (IO), sternal IO, and intravenous (i.v.) routes in a porcine model of cardiac arrest during cardiopulmonary resuscitation. Five pigs each were randomly assigned to 3 groups: tibial IO, sternal IO, and i.v. Cardiac arrest was induced with i.v. potassium chloride. ⋯ There were significant differences in Cmax between the sternal IO and i.v. (P = .009) and tibial IO and i.v. (P = .03) groups but no significant difference between tibial and sternal IO groups (P = .75). Significant differences existed in Tmax between the tibial IO and i.v. (P = .04) and between tibial IO and sternal IO (P = .02) groups but no difference between the sternal IO and i.v. groups (P = .56). Intravenous administration of 1 mg of epinephrine resulted in a serum concentration 5.87 and 2.86 times greater than for the tibial and sternal routes, respectively.
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Despite compelling evidence for the safety and efficacy of intrathecal hydromorphone, the use of this opioid intrathecally for the pain management of patients undergoing cesarean delivery has not been widely accepted. The purpose of this retrospective study was to compare the reported efficacy and safety of pain management in women who received intrathecal hydromorphone (100 microg) vs in women who received intrathecal fentanyl (25 microg) or a local anesthetic for their cesarean delivery. The author hypothesized that intrathecal hydromorphone because of its known pharmacodynamics would provide better postoperative analgesia within the first 24 hours after cesarean delivery. ⋯ Traditionally, intrathecal morphine was the opioid of choice for prolonged pain management during cesarean deliveries in which spinal anesthesia was selected. However, intrathecal hydromorphone was shown to be an effective and possibly even better substitute. Further research on intrathecal hydromorphone is needed.
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Randomized Controlled Trial Comparative Study
Effects of using simulation versus CD-ROM in the performance of ultrasound-guided regional anesthesia.
The purpose of this study was to determine which method of teaching, CD-ROM, simulation, or a combination of both, was more effective in increasing the performance of ultrasound-guided regional anesthesia. No studies have investigated these methods. The framework for this study was critical thinking. ⋯ The means and standard deviations for pretest and posttest results, respectively, were: CD-ROM, 33 +/- 7%, 41 +/- 9%; simulation, 35 +/- 10%, 49 +/- 13%; and combination, 36 +/- 8%, 64 +/- 17%. The baseline for each group was 0. Use of a combination of CD-ROM and simulation should be considered in teaching ultrasound-guided regional anesthesia techniques.
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Randomized Controlled Trial Controlled Clinical Trial
Effect of intraoperative intravenous lidocaine on postoperative pain and return of bowel function after laparoscopic abdominal gynecologic procedures.
Abdominal surgery has a high incidence of postoperative pain and dysfunctional gastrointestinal motility. This study investigated the effect of a continuous intraoperative infusion of lidocaine on patients undergoing laparoscopic gynecologic surgery. In this double-blind, placebo-controlled investigation, 50 subjects were randomly assigned to control and experimental groups. ⋯ Data were analyzed using descriptive and inferential statistics. A P value less than .05 was considered significant. These study results are consistent with previous research suggesting that intraoperative lidocaine infusion may improve postoperative pain levels and may shorten the time to return of bowel function.