CRNA : the clinical forum for nurse anesthetists
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Randomized Controlled Trial Clinical Trial
Effects of tourniquet time in knee arthroscopy patients receiving intraarticular morphine combined with bupivacaine.
The purpose of the study was to compare the duration of analgesia and the amount of supplemental postoperative analgesics required when morphine combined with bupivacaine was injected into the knee joint at the end of knee arthroscopy surgery. Varying tourniquet times of 0, 8, or 16 minutes were used after the injection. The variables examined were the duration of analgesia, and the amount of supplemental postoperative analgesics required in each subgroup. ⋯ No statistical differences were found between groups. All patients received analgesia with no reported side effects. Increasing the tourniquet time had no effect on the duration of analgesia or the amount of supplemental narcotics required in the postoperative period.
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Pipecuronium Bromide (Arduan, Organon, Inc, West Orange) is a long-acting, nondepolarizing neuromuscular blocking agent. The efficacy of pyridostigmine 170 micrograms/kg intravenously (approximately 10 mg/70 kg) for reversing pipecuronium has not been reported. This study was performed to determine the time required to obtain a train-of-four (TOF) ratio of 0.7 after administration of pyridostigmine 140 micrograms/kg at 25% recovery of T1 after pipecuronium-induced neuromuscular blockade. ⋯ Anesthesia was maintained with a nitrous oxide/narcotic technique and the use of potent inhalational anesthetics was avoided. The mean reversal time was found to be 16.14 minutes, with a minimum of 10.3 minutes and a maximum of 24.3 minutes. The standard error was +/- 1.05 minutes with a variance of 17.68 minutes.
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The purpose of this study was to determine the correlation between patient controlled analgesia and continuous epidural analgesia after total knee or total hip replacement on the length of hospital stay. Stress responses to postoperative pain, including decreased mobility, compromised respiratory function, increased catecholamine release, and hypercoagulation, may adversely affect patient recovery, thus lengthening hospital stay. A retrospective chart review of 127 adult, American Society of Anesthesiology (ASA) I, II, or III, patients who had undergone total knee arthroplasty (TKA) or total hip replacement (THR) was obtained. ⋯ These findings were not statistically significant at P = 0.054. LOS did not correlate with age, weight, height, type or surgery, or the ASA classification. Further research into the effectiveness of continuous infusion of epidural bupivacaine and epidural morphine and their impact on LOS may be warranted.
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Preemptive analgesia describes a situation where the administration of a pharmacological agent administered before the onset of a painful stimulus causes a decrease in the intensity of pain felt, and subsequently there is a decrease in the total amount of analgesic required compared with the administration of an agent after a painful stimulus. It is best understood if it is thought of as a block to afferent impulses that are trying to reach the central nervous system before a tissue injury. Preemptive analgesia, administered in the form of narcotics, nonsteroidal antiinflammatory agents, or local anesthetics, is thought to alter peripheral and central sensitization to nociceptive impulses.
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Post dural puncture headache is a common sequelae of spinal and, sometimes, epidural anesthesia. Since 1960, the practice of placing autologous blood into the epidural space to treat spinal headache has been used with great success. The blood patch can provide immediate symptom relief from spinal headache and repair of the CSF leak, which is the basic mechanism of post dural puncture headache. ⋯ This is a procedure not without complications and requires caution. Contained herein are recommendations for safe and effective use of the epidural blood patch. Following these procedures, anesthetists will likely see an 85% to 98% immediate cure rate for post dural puncture headache with the fewest possible complications.