Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1996
[Study of a protocol of intra-articular analgesia after arthroscopy of the knee].
The purpose of this study was to assess the analgesic effects of intra-articular injection of a morphine-bupivacaine combination following knee arthroscopy. 47 patients were evaluated. Knee arthroscopies were all performed under general anaesthesia, using propofol, alfentanil, isoflurane and nitrous oxide. Analgesic effects were evaluated by a visual analogic pain scale. ⋯ Analgesia was good in the immediate postoperative period, with minimal side effects. The serum bupivacaine levels were low. However the analgesic efficacy of intra-articular injection of morphine-bupivacaine should be corroborated through a double blind study.
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Cahiers d'anesthésiologie · Jan 1996
Biography Historical Article[History of anesthesia: Frederic Hewitt and nitrous oxide anesthesia].
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Cahiers d'anesthésiologie · Jan 1996
Comparative Study Clinical Trial Controlled Clinical Trial[Intra-articular analgesia after arthroscopy of the knee].
In 33 patients the authors compared two protocols for postoperative analgesia after elective arthroscopy of the knee. One group (n = 11) received plain bupivacaine 0.25% by intra-articular administration. ⋯ The last group (placebo group: n = 11) received the same volume of saline. The combination of bupivacaine with fentanyl reduced postoperative pain more effectively than plain bupivacaine and the analgesic effect was still present 9 hours after the arthroscopy.
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Isolated lower limb injuries are very common; difficulties for emergency anaesthesia may come from full stomach and drug interferences. The outcome of geriatric-fractured hip is influenced neither by a preoperative delay shorter than 48 hours, nor by the choice of anaesthetic technique; Nevertheless the use of acrylic cement is associated with an increased early mortality rate in hemiarthroplasties. ⋯ Spinal anaesthesia using 0.5% plain bupivacaine produces a block quickly achieved, not influenced by posture, allowing surgical installation and procedures. Postoperative analgesia using local anaesthetics may obscure symptoms of compartment syndrome which occasionally complicate tibial and femoral nailing.
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Combined spinal epidural (CSE) analgesia for labour is usually performed with sufentanil (or fentanyl) which provides powerful and fast onset pain relief (< or = 5 min). Dose reduction of sufentanil from 10 to 5 micrograms may be recommended and has little influence on the 1.5-2 hours of analgesia usually obtained. This mean duration of action may be prolonged by half an hour with the addition of a low dose of bupivacaine (< or = 2.5 mg). ⋯ Major improvement will be to prolong the excellent pain relief provided by intrathecal analgesia throughout the whole labour. This will require prolonging substantially the intrathecal analgesia duration and/ or influencing positively the epidural analgesia used afterwards. However, women prefer CSE technique to standard epidurals because of faster onset, less motor block, and feelings of greater self-control.