RESUMEN
OBJECTIVES: To study reduction in pain score after treatment with intravenous regional anesthesia (IVRA) and Stellate ganglion block (SGB) combination on complex regional pain syndrome (CPRS) patients and to quantify patients' satisfaction with treatment and occurrence of complications. METHODS: This is a record-based retrospective review carried out in 2020, targeting patients treated in the University of Jordan Hospital, Amman, Jordan, over the years 2002-2020. RESULTS: Among 99 patients, a significant drop in pain scores occurred in 88% of the patients' sample. Gender, age, type of CRPS, and duration of symptoms didn't affect statistical results. An average of 8.6 sessions needed to achieve 50% drop in pain score, and 2-3 sessions for first clinical improvement. Patients with previous application of plaster of Paris had increased success rates. CONCLUSION: We find it practical, inexpensive, safe, and straightforward to combine SGB with IVRA for CRPS patients.
Asunto(s)
Anestesia de Conducción , Síndromes de Dolor Regional Complejo , Distrofia Simpática Refleja , Humanos , Sulfato de Calcio/uso terapéutico , Síndromes de Dolor Regional Complejo/terapia , Dolor , Distrofia Simpática Refleja/diagnóstico , Distrofia Simpática Refleja/tratamiento farmacológico , Ganglio Estrellado , Centros de Atención TerciariaRESUMEN
OBJECTIVES: To evaluate the influence of the ORM1 variants in codon 118 on the intra-operative remifentanil consumption under general anesthesia. Methods: A prospective gene association study, performed at the Jordan University Jordan, Amman, Jordan from September 2013 to August 2014. It includes patients who underwent septoplasty surgery under general anesthesia. All patients received standard intravenous anesthesia. Anesthesia maintained with fixed dose of Sevoflurane and variable dose of Remifentanil to keep the systolic blood pressure between 90-100 mm Hg. The Remifentanil dose was calculated and correlated with ORM1 genotype variance. Results: Genotype and clinical data were available for 123 cases. The A118A genotype was seen in 96 patients (78%), the A118G genotype was seen in 25 patients (20.3%), and only 2 patients had genotype G118G (1.6%). The G118G variant was removed from the statistical analysis due to small sample size. There was a significant effect of ORM1 genotype variant and the amount of remifentanil consumed. The A118A genotype received 0.173 ± 0.063 µg kg-1 min-1 and the A118G genotype received 0.316 ± 0.100 µg kg-1 min-1 (p less than 0.0001). Conclusion: The ORM1 gene has a role in intra-operative remifentanil consumption in patients who underwent septoplasty surgery under general anesthesia. The A118G gene required higher dose of remifentanil compared with the A118A genotype.
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Anestesia General/métodos , Anestésicos Intravenosos/administración & dosificación , Tabique Nasal/cirugía , Piperidinas/administración & dosificación , Polimorfismo de Nucleótido Simple/genética , Receptores Opioides mu/genética , Adulto , Anestesia General/estadística & datos numéricos , Femenino , Genotipo , Humanos , Periodo Intraoperatorio , Masculino , Estudios Prospectivos , Remifentanilo , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Data are still insufficient about the effects of different concentrations of caudal dexmedetomidine when used to prolong postoperative analgesia in children. The aim of this study was to assess the analgesic efficacy and side effects of two doses of caudal dexmedetomidine (1 and 2 µg·kg(-1)) co-administered with bupivacaine in terms of postoperative pain scores and requirement of postoperative analgesia over 24 h in children undergoing infra-umbilical surgery. METHODS: Ninety-one children, aged 1-6 years, undergoing infra-umbilical surgery were included and randomly allocated into three groups of caudal block. Group B received 0.25% bupivacaine 2 mg·kg(-1) (0.8 ml·kg(-1)). Groups BD1 and BD2 received dexmedetomidine 1 and 2 µg·kg(-1), respectively along with bupivacaine 2 mg·kg(-1) in a total volume of 0.8 ml·kg(-1). Anesthesia was induced and maintained with sevoflurane in 100% oxygen. Hemodynamic and other routine intraoperative monitoring was carried out in addition to endtidal sevoflurane concentration. Time to spontaneous eye opening and postoperative pain and sedation scores were recorded in addition to time to first analgesia, paracetamol analgesic requirements, and any side effects during the first 24 postoperative hours. RESULTS: Time to first analgesia requirement was significantly longer in BD1 and BD2 groups compared to B group with mean values (95% CI) of 809 min (652-965), 880 (733-1026), and 396 (343-448), respectively, P < 0.001. Postoperative paracetamol analgesic requirements over 24 h were higher in group B compared to BD1 and BD2 groups (Mean (95% CI): 3.2 (2.9-3.5) doses, 1.9 (1.5-2.3), and 1.6 (1.3-1.9), respectively), P < 0.001. The dexmedetomidine groups had significantly higher postoperative sedation scores compared to plain bupivacaine group that were dose dependent and for longer time in BD2 group. Two patients in BD2 group developed bradycardia and hypotension, and one developed urine retention compared to none in other groups. CONCLUSION: A 1 µg·kg(-1) dose of caudal dexmedetomidine achieved comparable prolongation of postoperative analgesia to 2 µg·kg(-1) dose, with shorter duration of postoperative sedation and lower incidence of other side effects.
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Abdomen/cirugía , Analgesia/métodos , Anestesia Caudal/métodos , Bupivacaína , Dexmedetomidina , Dolor Postoperatorio/tratamiento farmacológico , Anestésicos Locales , Niño , Preescolar , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Hipnóticos y Sedantes , Lactante , Masculino , Perineo/cirugía , Estudios ProspectivosRESUMEN
UNLABELLED: Recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. One physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. METHODS: 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h(-1) ropivacaine 0.2% (study group, n = 21) or 5 ml*h(-1) saline (control group, n = 21). Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia (PCEA) with ropivacaine 0.2%. The main outcome measure was the concentration of authentic beta-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol. RESULTS: Both groups were comparable concerning preoperative parameters and pain scores. Epidural blocks were sufficient in all patients for operative analgesia. Preemptive analgesia was performed for 11-20 hours in both groups and led to significantly decreased pain scores before surgery. Preemptive analgesia with epidural ropivacaine did not lead to decreased concentrations of beta-endorphin [1-31] before the start of surgery or in the postoperative period. Furthermore, no differences could be detected in the time course of beta-endorphin and adrenocorticotrope hormone after surgery. However, cortisol concentrations differed significantly between groups before the operation, but showed a comparable rise after surgery. CONCLUSION: Differences in postoperative pain after preemptive analgesia do not seem to be due to an altered endogenous opioid response.
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Hormona Adrenocorticotrópica/sangre , Analgesia Epidural , Artroplastia de Reemplazo de Cadera , Hidrocortisona/sangre , Dolor Postoperatorio/prevención & control , betaendorfina/sangre , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Horner's syndrome is rarely reported after epidural analgesia during labor. The use of Top-Up local anesthetic for controlling labor pain in the first stage of labor, or to dense the block in caesarean deliveries can result in this complication. We reported a cases of Horner's syndrome during epidural analgesia in labor in spite of not giving any Top-Up dose. The case was clinically evident and was successfully managed by stopping the epidural infusion, and reassuring the parturient as well as the family; until the disappearance of the signs and symptoms. The infusion was then restarted, delivery was uneventful and no consequent neurological or psychological problems were noticed after a one-month follow-up.
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Analgesia Epidural/efectos adversos , Analgesia Obstétrica/efectos adversos , Síndrome de Horner/etiología , Adulto , Femenino , Humanos , Región Lumbosacra , EmbarazoRESUMEN
Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, creatinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients). The mean onset time for impaired or reduced sensation was found to be 8.9 +/- 4.7 mins and for complete loss of sensation, was 21.2 +/- 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P > 0.05). The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P = 0.00, 0.019). Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.
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Anestésicos Combinados/administración & dosificación , Anestésicos Locales/administración & dosificación , Bicarbonatos/sangre , Plexo Braquial/efectos de los fármacos , Bupivacaína/administración & dosificación , Fallo Renal Crónico/sangre , Lidocaína/administración & dosificación , Bloqueo Nervioso/métodos , Adulto , Anciano , Derivación Arteriovenosa Quirúrgica , Biomarcadores/sangre , Regulación hacia Abajo , Femenino , Humanos , Riñón/fisiopatología , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Actividad Motora/efectos de los fármacos , Estudios Prospectivos , Diálisis Renal , Sensación/efectos de los fármacosRESUMEN
BACKGROUND: The present study was designed to assess whether an intraoperative administration of dexmedetomidine would decrease the intraoperative and postoperative analgesic requirements for paediatric patients undergoing hypospadius surgery. METHODS: Forty-eight children (American Society of Anesthesiologists-1) aged 1-12 years undergoing hypospadius repair under general anaesthesia were randomly assigned into dexmedetomidine or placebo groups, D and P, respectively. Group D received a loading dose of dexmedetomidine 1 microg kg(-1) after induction of anaesthesia, followed by a continuous infusion at a rate of 0.7 microg kg(-1) h(-1). Group P received a volume-matched 0.9% saline. Both groups received fentanyl for intraoperative analgesia and intravenous morphine and oral paracetamol for postoperative analgesia. For both groups, heart rate, blood pressure and fentanyl requirements were recorded intraoperatively. During their stay for 2 h in the recovery room, heart rate, blood pressure, pain scores, behaviour scores and total morphine requirements were recorded. After discharge from postanaesthesia care unit, paracetamol requirements over 24 h were also recorded. RESULTS: Intraoperatively, the dexmedetomidine-treated group had significantly fewer fentanyl requirements, slower heart rate and lower mean arterial blood pressure (P < 0.001). In the postanaesthesia care unit, this group also consumed significantly less morphine, had lower pain scores, lower behaviour score in the immediate postoperative period, lower heart rates and mean arterial blood pressures when compared with the placebo group (P < 0.001). Group D consumed significantly less paracetamol than group P in the ward over 24 h. CONCLUSION: Intravenous administration of dexmedetomidine intraoperatively during hypospadius repair in children reduces intraoperative and postoperative analgesic requirements and lowers heart rate and blood pressure.
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Analgesia/estadística & datos numéricos , Dexmedetomidina/administración & dosificación , Hipospadias/tratamiento farmacológico , Hipospadias/cirugía , Cuidados Intraoperatorios , Analgesia/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Cuidados Intraoperatorios/métodos , Masculino , Dolor Postoperatorio/prevención & controlRESUMEN
OBJECTIVE: To evaluate the effect of adding dexmedetomidine to a balanced anesthetic technique on postoperative nausea and vomiting after laparoscopic gynecological surgeries. METHODS: A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between December 2008 and February 2009. Eighty-one female patients in their child-bearing age (17-48 years); American Society of Anesthesiologists (ASA) clinical status I, who were scheduled for elective diagnostic laparoscopic surgeries under general anesthesia were divided into 2 groups. Group D (n=42) received dexmedetomidine infusion, while group P (n=39) received 0.9% sodium chloride infusion along with the balanced anesthesia. The incidence of early (up to 24 hours) postoperative nausea, vomiting, nausea and vomiting, and the need for postoperative rescue anti-emetic medications were recorded. RESULTS: The total incidence of postoperative nausea and vomiting decreased significantly in group D; 13 out of 42 patients (31%), compared to group P; 23 out of 39 patients (59%), vomiting alone did not significantly change, the incidence of postoperative nausea, and the use of rescue anti-emetic medications were significantly different. A significant drop in overall consumption of fentanyl and sevoflurane was also noted in group D. CONCLUSION: Combining dexmedetomidine to other anesthetic agents, results in more balanced anesthesia and a significant drop in the incidence of postoperative nausea and vomiting after laparoscopic gynecological surgeries.
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Dexmedetomidina/uso terapéutico , Laparoscopía/efectos adversos , Náusea y Vómito Posoperatorios/prevención & control , Adolescente , Adulto , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-obese patients undergoing abdominal surgeries. METHODS: We prospectively evaluated the levels of the serum concentration of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil), in 42 morbidly obese and 40 non obese patients who were scheduled for elective abdominal surgery under sevoflurane anesthesia at the Jordan University Hospital, Amman, Jordan. Measurement of liver enzymes was done in the recovery room, and on the first, 3 and 7 days after sevoflurane anesthesia, and the results were compared between the morbidly obese and non obese patients. RESULTS: ALT, AST, GGT and LDH increased significantly in the morbidly obese than they did in non obese patients. In morbidly obese patients TBil increased gradually peaking 7 days after anesthesia, LDH increased in the recovery room, AST and ALT increased in the recovery room and first day, while GGT increased 7th day after anesthesia. In non obese patients, AST, LDH increased in the recovery. ALP did not change in both groups. CONCLUSION: Sevoflurane induces elevation of the serum liver enzymes in morbidly obese patients with variable onsets.
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Anestésicos por Inhalación/efectos adversos , Hígado/efectos de los fármacos , Éteres Metílicos/efectos adversos , Obesidad Mórbida/complicaciones , Abdomen/cirugía , Adolescente , Adulto , Anciano , Anestésicos por Inhalación/uso terapéutico , Femenino , Hospitales Universitarios , Humanos , Hígado/metabolismo , Pruebas de Función Hepática , Masculino , Éteres Metílicos/uso terapéutico , Persona de Mediana Edad , Complicaciones Posoperatorias/inducido químicamente , Estudios Prospectivos , Sevoflurano , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha 2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. METHODS: 48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C (the control group) received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05). The duration of motor block was longer in dexmedetomidine group than control group (199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05). CONCLUSION: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability.
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Agonistas alfa-Adrenérgicos/farmacología , Anestésicos Locales/farmacología , Bupivacaína/farmacología , Dexmedetomidina/farmacología , Anciano , Anestesia Raquidea/métodos , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Factores de TiempoRESUMEN
OBJECTIVES: To determine the effect of adding dexmedetomidine to bupivacaine for neuraxial anesthesia. METHODS: Sixty-six patients were studied between April and May 2008 in the University of Jordan, Amman Jordan. They were randomly assigned into 3 groups, each receiving spinal bupivacaine 12.5mg combined with normal saline (group N) Dexmedetomidine 5 microg (group D5), or dexmedetomidine 10 microg (group D10). The onset times to reach T10 sensory and Bromage 3 motor block, and the regression times to reach S1 sensory level and Bromage 0 motor scale, were recorded. RESULTS: The mean time of sensory block to reach the T10 dermatome was 4.7 +/- 2.0 minutes in D10 group, 6.3 +/- 2.7 minutes in D5, and 9.5 +/- 3.0 minutes in group N. The mean time to reach Bromage 3 scale was 10.4 +/- 3.4 minutes in group D10, 13.0+/-3.4 minutes in D5, and 18.0 +/- 3.3 minutes in group N. The regression time to reach S1 dermatome was 338.9 +/- 44.8 minutes in group D10, 277.1 +/- 23.2 minutes in D5, and 165.5 +/- 32.9 minutes in group N. The regression to Bromage 0 was 302.9 +/- 36.7 minutes in D10, 246.4 +/- 25.7 minutes in D5, and 140.1 +/- 32.3 minutes in group N. Onset and regression of sensory and motor block were highly significant (N vesus D5, N versus D10, and D5 versus D10, p<0.001). CONCLUSION: Dexmedetomidine has a dose dependant effect on the onset and regression of sensory and motor block when used as an adjuvant to bupivacaine in spinal anesthesia.