Spinal versus general anesthesia in cesarean sections: the effects on postoperative pain perception

Paravertebral blocks are becoming increasingly utilized for breast surgery with studies showing improved postoperative pain control, decreased need for opioids, and less nausea and vomiting. We describe the anesthetic management of an otherwise healthy woman who was 12 weeks pregnant presenting for treatment of her breast cancer. For patients undergoing breast mastectomy and reconstruction with tissue expanders, paravertebral blocks offer an anesthetic alternative when general anesthesia is not desired.

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Effect of Preoperative Intravenous Oxycodone After Transurethral Resection of Prostate Under General Anesthesia

International Surgery ◽

10.9738/intsurg-d-15-00087.1 ◽

2017 ◽

Vol 102 (7-8) ◽

pp. 377-381

Author(s):

Jinguo Wang ◽

Yaowen Fu ◽

Haichun Ma ◽

Na Wang

Keyword(s):

Urinary Tract ◽

Postoperative Pain ◽

Adverse Effects ◽

General Anesthesia ◽

Transurethral Resection ◽

Lower Urinary Tract ◽

Airway Device ◽

Time Interval ◽

Transurethral Resection Of Prostate ◽

Lower Urinary

The objective of this study was to investigate the effect of intravenous oxycodone administered before transurethral resection of prostate (TURP) on postoperative pain and tramadol consumption. Preemptive analgesia can decrease postoperative pain and analgesic consumption. Sixty patients undergoing elective TURP were divided into 2 groups: group O (n = 30) received intravenous oxycodone (0.1 mg/kg) 10 minutes before surgery over 2 minutes and group C (n = 30) received normal saline as a placebo. A standardized general anesthesia method was performed with a laryngeal mask airway device. Data with respect to pain intensity, incidence of lower urinary tract discomfort, time to the first tramadol requirement, tramadol consumption, overall patient satisfaction, and adverse effects were collected. Preoperative oxycodone contributed to better analgesia at 1, 2, 6, and 12 hours after shifting the patients to the recovery room, a longer time interval to the first tramadol request, fewer patients requiring tramadol analgesia, and reduced tramadol consumption. Adverse effects were comparable between the 2 groups. Preoperative intravenous oxycodone (0.1 mg/kg) 10 minutes before TURP improves postoperative analgesia, prolongs time to the first tramadol request, and reduces tramadol consumption without an influence on lower urinary tract discomfort and adverse effects.

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Effects of Ultrasound-Guided Paravertebral Block on MMP-9 and Postoperative Pain in Patients Undergoing VATS Lobectomy: A Randomized, Controlled Clinical Trial

10.21203/rs.2.18752/v3 ◽

2020 ◽

Author(s):

Haichen Chu ◽

He Dong ◽

Yongjie Wang ◽

Zejun Niu

Keyword(s):

Postoperative Pain ◽

General Anesthesia ◽

Tumor Recurrence ◽

Tertiary Care ◽

Plasma Concentrations ◽

Paravertebral Block ◽

Secondary Outcome ◽

Anesthetic Technique ◽

Vats Lobectomy ◽

Pain Scores

Abstract Background: Local anesthesia can reduce the response to surgical stress and decrease the consumption of opioids, which may reduce immunosuppression and potentially delay postoperative tumor recurrence. We compared paravertebral block(PVB) combined with general anesthesia(GA) and general anesthesia regarding their effects on matrix metalloproteinase-9 (MMP-9) and postoperative pain after video-assisted thoracoscopic surgery(VATS) lobectomy. Methods: 54 patients undergoing elective VATS lobectomy at a single tertiary care, teaching hospital located in Qingdao between May 2 2018 and Sep 28 2018 were randomised by computer to either paravertebral block combined with general anesthesia or general anesthesia. The primary outcome was pain scores during postoperative 48h. The secondary outcome were plasma concentrations of MMP-9, complications, and duration of postoperative hospital stay. Results: 75 were enrolled to the study, of whom 21 were excluded before surgery. We analyzed lobectomy patients undergoing paravertebral block combined with general anesthesia (n=25) or general anesthesia (n=24). Both groups were similar regarding baseline characteristics. Pain scores were lower at 4h and 24h in PVB/GA group, compared with GA group (2.53±0.83 vs 3.4±0.91; 2.2±0.94 vs 3.0±0.93, respectively, P <0.05). There were no difference at 1h and 48h between groups. Patients in the PVB/GA group showed a greater decrease in plasma MMP-9 level at T1 and T2 after VATS lobectomy ( P <0.05). Postoperative complications and length of stay did not differ by anesthetic technique. Conclusions: The paravertebral block/general anesthesia can provide statistically better pain relief and attenuate MMP-9 response to surgery and after VATS lobectomy. This technique may be beneficial for patients to recover rapidly after lung surgery and reduce postoperative tumor recurrence.

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Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v25i1.1434 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Mukesh Kumar Prasad ◽

Payal Jain ◽

Rohit Kumar Varshney ◽

Aditi Khare ◽

Gurdeep Singh Jheetay

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Blood Loss ◽

General Anesthesia ◽

Local Anesthesia ◽

Skin Graft ◽

Tumescent Local Anesthesia ◽

Graft Harvest ◽

Contracture Release ◽

Split Skin

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique. Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale). Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group. Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia. Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39. DOI: 10.35975/apic.v25i1.1434 Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

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