Cahiers d'anesthésiologie
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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.
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Cahiers d'anesthésiologie · Jan 1996
[Intraosseous device of perfusion. Apropos of 3 cases before hospitalization].
A renewal of interest in the intraosseous route has appeared lately in France. It concerns pediatric patients. ⋯ Our modest experience enables us to present three observations where intraosseous route has been used outside hospital in children suffering a cardiopulmonary arrest on arrival of the practitioner belonging to the mobile emergency unit. This rapid and easy to place technique seems to be attractive as an alternative to the intravenous route in situations of utmost emergency, this all the more so since there are few reported contraindications and complications.
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Despite physiological advances and recent progress in pain relief, early analgesia for patients with acute abdominal pain is not a conventional endpoint. In clinical practice, priority is often given to diagnosis and management decisions. There are few controlled trials to settle the issue and opinions are still divided. recent studies suggest than early and effective analgesia in acute abdomen does not interfere with diagnosis, and even facilitates initial examination. Various modes of analgesia can be considered.