Articles: postoperative.
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Rev Bras Anestesiol · Oct 2006
[Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine.].
Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become increasingly more popular. The objective of this study was to determine the prevalence of diaphragmatic paralysis after interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine. ⋯ We observed that brachial plexus blockade by the posterior approach is associated with a high prevalence of diaphragmatic paralysis, even with low concentrations of local anesthetics.
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Rev Bras Anestesiol · Aug 2006
[Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?].
The mechanism of action of alpha2-adrenergic analgesia has been explored for more than one hundred years. The increased duration of the sensitive and motor blockades caused by clonidine is dose-dependent and has antinociceptive properties. The objective of this study was to evaluate whether the addition of 15 to 30 microg of clonidine to spinal anesthesia for cesarean sections with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) improves the quality of postoperative analgesia. ⋯ The addition of clonidine to spinal anesthesia with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) for cesarean section improved the quality of the postoperative analgesia without increasing the incidence of side effects. We suggest that the dose of 15 microg of clonidine should be used.
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To investigate the efficacy of single injection femoral nerve block (FNB) on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty (TKA). ⋯ Single injection FNB provided effective analgesia in patients undergoing TKA. However, the independence level in functional activities in the early postoperative period was not influenced by the analgesia method.
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Management of hemostasis of cardiopulmonary bypass (CPB) patients is still a major challenge. New monitoring methods, new hemostatic drugs and new platelet function inhibitors are being added to the pre, intra and postoperative periods. The multifactorial nature of CBP-induced hemostasis disorders requires the understanding of their pathophysiology and the accurate hemostasis evaluation for effective coagulation during CPB, in addition to the maintenance of adequate postoperative hemostasis. Activated clotting time (ACT) and coagulogram are not enough for this management. A broader evaluation is needed with monitors able to measure platelet function and hemostatic process dynamics as a whole. ⋯ Thromboelastograph is an important hemostasis monitor for patients submitted to CPB. It has been incorporated to hemostatic disorders evaluation protocols and transfusion therapy, with good results.
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A considerable number of patients require opioids during recovery after laparoscopic sterilization. This implies nausea, dizziness and sedation and increases the number of unplanned admissions. Gabapentin has shown excellent postoperative analgesic effect in a number of recent studies with few side effects. This study was designed to test whether gabapentin given preoperatively can reduce the number of patients needing morphine in the recovery period. ⋯ The postoperative analgesic effect of gabapentin given preoperatively was confirmed in this study. For this procedure, with pain predominantly in the immediate recovery period, and of less intensity than after major surgical procedures, the effect demonstrated is much less pronounced than in similar studies of major surgery. General use of gabapentin as analgesic for laparoscopic sterilization is not supported by this study.