This document describes a study comparing the analgesic effects of thoracic paravertebral block using bupivacaine-sufentanil versus intravenous patient-controlled analgesia using morphine after kidney-ureter surgery. 58 patients undergoing kidney-ureter surgery were divided into two groups. The study measured pain scores, total analgesic requirements, side effects, and patient satisfaction in the first 2 days post-surgery. The results showed that thoracic paravertebral block provided better pain relief with fewer side effects and higher patient satisfaction compared to intravenous morphine patient-controlled analgesia.
A prospective, randomized, double blind study to evaluate Morphine sparing ef...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A prospective, randomized, double blind study to evaluate Morphine sparing ef...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiti...Apollo Hospitals
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)Saeid Safari
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY (American Society of Anesthesiologists)
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY
Non–Operating Room Anesthesia (NORA)
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
In thoracolumbar spine trauma, the biomechanical goals in minimally invasive fracture treatment include decompression of the spinal canal, reduction of spinal deformities, and maintenance of stable fixation of the spine to permit early mobilization.
This was a teaching lecture given by Prof. Mohamed Mohi Eldin, professor of neurosurgery, in the Multi- Institutional Neurosurgical Meeting, Kasr El Aini Hospital, Cairo University, April 2nd, 2009.
Dr. Gabriel López-Berestein- Simposio Internacional 'Terapias oncológicas ava...Fundación Ramón Areces
Los días 15 y 16 de octubre de 2014, la Fundación Ramón Areces y la Real Academia Nacional de Farmacia, en colaboración con la Fundación de la Innovación Bankinter, reunieron en Madrid a algunos de los mayores expertos mundiales en nuevas terapias contra el cáncer. El Simposio Internacional, coordinado por la profesora y académica María José Alonso, analizó el momento actual de la lucha contra esta enfermedad. También fue un punto de encuentro para científicos de los más innovadores institutos de investigación en oncología, quienes debatieron sobre tres grandes temas: la Medicina Personalizada contra el cáncer, los nanomedicamentos en la terapia del cáncer y las terapias basadas en la inmunomodulación.
Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiti...Apollo Hospitals
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)Saeid Safari
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY (American Society of Anesthesiologists)
GUIDELINES FOR AMBULATORY ANESTHESIA AND SURGERY
Non–Operating Room Anesthesia (NORA)
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
In thoracolumbar spine trauma, the biomechanical goals in minimally invasive fracture treatment include decompression of the spinal canal, reduction of spinal deformities, and maintenance of stable fixation of the spine to permit early mobilization.
This was a teaching lecture given by Prof. Mohamed Mohi Eldin, professor of neurosurgery, in the Multi- Institutional Neurosurgical Meeting, Kasr El Aini Hospital, Cairo University, April 2nd, 2009.
Dr. Gabriel López-Berestein- Simposio Internacional 'Terapias oncológicas ava...Fundación Ramón Areces
Los días 15 y 16 de octubre de 2014, la Fundación Ramón Areces y la Real Academia Nacional de Farmacia, en colaboración con la Fundación de la Innovación Bankinter, reunieron en Madrid a algunos de los mayores expertos mundiales en nuevas terapias contra el cáncer. El Simposio Internacional, coordinado por la profesora y académica María José Alonso, analizó el momento actual de la lucha contra esta enfermedad. También fue un punto de encuentro para científicos de los más innovadores institutos de investigación en oncología, quienes debatieron sobre tres grandes temas: la Medicina Personalizada contra el cáncer, los nanomedicamentos en la terapia del cáncer y las terapias basadas en la inmunomodulación.
Newer Truncal Blocks Do they have place in current practice.pptxashokJadon4
Interfascial plane blocks also known as Truncal blocks are US guided regional blocks of thorax and abdomen. They have been used extensively for acute pain management and now their role is further expanding for chronic pain conditions. It has been suggested that they work by neural adhesiolysis, breaking the pain cycle by blocking the pain signals and also by anti-inflammatory action of steroids used with local anesthetic.
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
In a prospective double blind randomized study we evaluated the prophylactic anti emetic efficacy of granisetron, a 5HT3 receptor antagonist and metoclopramide, a benzamide anti emetic on postoperative nausea and vomiting after major gynaecological surgery under general anaesthesia. The patients received a single dose of granisetron, 40mcg/kg (Group A, n = 25) or metoclopramide, 0.15mg/kg (Group B, n = 25) before induction of anaesthesia in a coded syringe. The response was assessed during 0-4 hrs, 4-8 hrs, 8-16hrs and 16-24 hrs time intervals after recovery from anaesthesia by means of presence or absence of nausea, retching or vomiting. The overall control of PONV during early postoperative period (0-4 hrs) did not show statistically significant differences after administration of either drug. The incidence of PONV during the next 20 hours was 12% and 48% with Group A (Granisetron) and Group B (Metoclopramide) respectively. Nausea scores are significantly lower in-group A (Granisetron) than in Group B (Metoclopramide) in all the four assessment periods. Although there were no emetic episodes in the granisetron group, 32% of patients in metoclopramide group were observed to have such episodes during the assessment periods. (P value< 0.05). No clinically important adverse events due to drugs were observed in any of the groups. In conclusion, the prophylactic use of granisetron is more effective and superior to metoclopramide in preventing postoperative nausea and vomiting in patients under going major gynaecological surgery under general anaesthesia.
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
In a prospective double blind randomized study we evaluated the prophylactic anti emetic efficacy of granisetron, a 5HT3 receptor antagonist and metoclopramide, a benzamide anti emetic on postoperative nausea and vomiting after major gynaecological surgery under general anaesthesia. The patients received a single dose of granisetron, 40mcg/kg (Group A, n = 25) or metoclopramide, 0.15mg/kg (Group B, n = 25) before induction of anaesthesia in a coded syringe. The response was assessed during 0-4 hrs, 4-8 hrs, 8-16hrs and 16-24 hrs time intervals after recovery from anaesthesia by means of presence or absence of nausea, retching or vomiting. The overall control of PONV during early postoperative period (0-4 hrs) did not show statistically significant differences after administration of either drug. The incidence of PONV during the next 20 hours was 12% and 48% with Group A (Granisetron) and Group B (Metoclopramide) respectively. Nausea scores are significantly lower in-group A (Granisetron) than in Group B (Metoclopramide) in all the four assessment periods. Although there were no emetic episodes in the granisetron group, 32% of patients in metoclopramide group were observed to have such episodes during the assessment periods. (P value< 0.05). No clinically important adverse events due to drugs were observed in any of the groups. In conclusion, the prophylactic use of granisetron is more effective and superior to metoclopramide in preventing postoperative nausea and vomiting in patients under going major gynaecological surgery under general anaesthesia.
1. Ministry of Education and Training Ministry of Health
Bach Mai Hospital
NGUYEN HONG THUY
Comparison of analgesic effects of thoracic
paravertebral block by bupivacaine-sufentanil
with morphine intravenously
patient controlled analgesia after kidney-ureter
surgery
Vice professor. NGUYỄN QUỐC ANH
Professor. NGUYỄN QUỐC KÍNH
3. Objective
11.. Comparison of analgesic effects of thoracic
paravertebral block by bupivacaine-sufentanil
with morphine intravenously patient controlled
analgesia after kidney-ureter surgery block
by
22.. CCoommppaarriissoonn ooff side effects ooff ttwwoo mmeetthhooddss..
4. Subjects and Methods
Criteria included
Open surgery under the program with renal
and ureteral an incision unilateral.
Age over 18, regardless of gender, agreed
collaborative research.
Physical body ASA status I - II and I.renal ≤ 2.
Anesthesia endotracheal and is expected to
extubation in the recovery room
No contraindications of TPVB
No contraindications of anesthetic bupivacaine,
sufentanil and morphine.
5. Subjects and Methods
Exclusion criteria included
Patients’ refusal
Planned bilateral kidney-ureter surgery
Patients with a history and current mental disease
Patients with severe cardiopulmonary disease,
severe liver failure, kidney failure grade 3-4.
History of opioid dependence or addiction
Contraindications of Thoracic Paravertebral Block
Complications of surgery and anesthesia; required
prolonged mechanical ventilation (over 4 hours) in
the recovery room or intensive care.
6. SSuubbjjeeccttss aanndd MMeetthhooddss
SSttuuddyy DDeessiiggnn:: Random ::ised Controlled Clinical
Trials
SSaammppllee ssiizzee :: 58 patients were divided into 2
groups
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•• GGrroouupp 22:: PPCCAA wwiitthh mmoorrpphhiinnee..
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-- TTiimmee ssttuuddyy:: from 9/2013 to 06/2014..
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-- In Anesthesiology Health Bach Mai Hospital
7. Subjects and Methods
* OPERATION
1. Patients anesthetized preparation
2. Preparation machines, instruments, drugs
* Preparation of drugs
+ Local anesthetic: - Lidocain 2% tube 10 ml (Hungari),
Sufentanil tube 50mg/1 ml, Bupivacain 0,5% tube 20ml-
AstraZeneca, Adrenaline tube 1mg/1ml.
+ Morphin tube 10mg = 1ml
+ Anesthetics and resuscitation
* Sterile instruments for anesthesia: epidural anesthesia
needle; syringes, sterile tray and attempted shirt, betadin
antiseptic solution, sterile gant.
9. SSuubbjjeeccttss aanndd MMeetthhooddss
Thoracic Paravertebral Block: a loss of resistance
Positions anesthesia
spinous process
paravertebral space
2,5 cm
Transverse process
Pleural
T9-10
10. SSuubbjjeeccttss aanndd MMeetthhooddss
Method of endotracheal anesthesia in
a common regimen
* Pre-anesthesia: midazolam
* Induction: propofol, fentanyl, curare
* Maintenance of anesthesia: propofol, fentanyl,
curare.
* Patients were awakened and extubation:
in the recovery room
31. RESULTS AND DISCUSSIONS
Side effects: nausea, vomiting, pruritus
0 1 2 3 4 5 6 7 8
Số lượng
bệnh nhân
Biểu đồ tác dụng phụ
Buồn
nôn
Nôn Mẩn
ngứa Tác dụng phụ
Nhóm Tê CCSN Nhóm PCA
p<0,05
Our Results: TPVB 17,2% sv PCA 41,3%, p<0,05.
Karger 2013, nephrolithotomy, single-dose, nausea, vomiting: TPVB 8% sv
PCA 42,8%, p<0,05; Emmanuel 2005, postthoracotomy, nausea, vomiting:
TPVB 5% sv PCA 45%, p<0,05; Ashraf 2007, laparoscopic cholecystectomy,
TBVB 14,2% sv PCA 57,1%, p<0,05.
32. RESULTS AND DISCUSSIONS
Side effects: Sedation level, time of gaz
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<<00,,0055
MMiinn -- MMaaxx 11--33 11-- 44
Time of
gaz ((hh))
XX ± SSDD 4488,,3344 ±±88,,5533 5599,,0033 ±±55,,7755
<<00,,0055
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33. CCOONNCCLLUUSSIIOONN
Effective analgesic of thoracic paravertebral block by
bupivacaine-sufentanil is better morphine intravenous PCA after
kidney-ureter surgery:
VAS score was lower in static and dynamic
The rate higher satisfaction
Side effects: nausea, vomiting, pruritus, sedation level lower.
Gaz shorter time
The complications: vascular puncture 3.4%, other
complications not encountered (local anesthetic toxicity, pleural
puncture, pneumothorax ...).