Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery

2007 ◽  
Vol 51 (4) ◽  
pp. 482-489 ◽  
Author(s):  
R. Arcioni ◽  
S. Palmisani ◽  
S. Tigano ◽  
C. Santorsola ◽  
V. Sauli ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Controlled Trial ◽  
Double Blind ◽  
Major Orthopedic Surgery

scholarly journals Antifibrinolytic Therapy and Perioperative Blood Loss in Cancer Patients Undergoing Major Orthopedic Surgery

2003 ◽  
Vol 98 (2) ◽  
pp. 337-342 ◽  
Author(s):  
David Amar ◽  
Florence M. Grant ◽  
Hao Zhang ◽  
Patrick J. Boland ◽  
Denis H. Leung ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cancer Patients ◽  
Orthopedic Surgery ◽  
Controlled Trial ◽  
Caproic Acid ◽  
Double Blind ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements ◽  
Major Orthopedic Surgery ◽  
Duration Of Surgery

Background Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether epsilon amino-caproic acid (EACA) is effective in this population are sparse. Methods Sixty-nine adults with malignancy scheduled for either pelvic, extremity or spine surgery during general anesthesia entered this randomized, double-blind, placebo-controlled trial, and received either intravenous aprotinin (n = 23), bolus of 2 x 10(6) kallikrein inactivator units (KIU), followed by an infusion of 5 x 10(5) KIU/h, or EACA (n = 22), bolus of 150 mg/kg, followed by a 15 mg/kg/h infusion or saline placebo (n = 24) during surgery. Our goal was to determine whether prophylactic EACA or aprotinin therapy would reduce perioperative blood loss (intraoperative + first 48h) >30% when compared to placebo. Results The mean age of the study population was 52 +/- 17 yr. The groups did not differ in age, duration of surgery, perioperative blood loss or number of packed erythrocyte units transfused. When compared to the placebo group, the two treated groups had a significantly lower D-Dimer level immediately after surgery, P < 0.01. Conclusions Under the conditions of this study, we were unable to find a clinical benefit to using aprotinin or EACA to reduce perioperative blood loss or transfusion requirements during major orthopedic surgery in cancer patients.

scholarly journals The Quality of Recovery after Dexamethasone, Ondansetron, or Placebo Administration in Patients Undergoing Lower Limbs Orthopedic Surgery under Spinal Anesthesia Using Intrathecal Morphine. A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Eduardo Toshiyuki Moro ◽  
Miguel Antônio Teixeira Ferreira ◽  
Renyer dos Santos Gonçalves ◽  
Roberta Costa Vargas ◽  
Samira Joverno Calil ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Intrathecal Morphine ◽  
Controlled Trial ◽  
Lower Limbs ◽  
Postanesthesia Care Unit ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
To Receive

Intrathecal morphine is widely and successfully used to prevent postoperative pain after orthopedic surgery, but it is frequently associated with side effects. The aim of this study was to evaluate the effect of dexamethasone or ondansetron when compared to placebo to reduce the occurrence of these undesirable effects and, consequently, to improve the quality of recovery based on patient’s perspective. Methods. One hundred and thirty-five patients undergoing lower extremity orthopedic surgery under spinal anesthesia using bupivacaine and morphine were randomly assigned to receive IV dexamethasone, ondansetron, or saline. On the morning following surgery, a quality of recovery questionnaire (QoR-40) was completed. Results. No differences were detected in the global and dimensional QoR-40 scores following surgery; however, following postanesthesia care unit (PACU) discharge, pain scores were higher in patients receiving ondansetron compared with patients who received dexamethasone. Conclusion. Neither ondansetron nor dexamethasone improves the quality of recovery after lower limbs orthopedic surgery under spinal anesthesia using intrathecal morphine.

scholarly journals Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

2009 ◽  
Vol 127 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Luiz Eduardo Imbelloni ◽  
Marildo Assunção Gouveia ◽  
José Antonio Cordeiro
Keyword(s):  
Clinical Study ◽  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Motor Blockade ◽  
Continuous Spinal Anesthesia ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Major Orthopedic Surgery ◽  
Spinal Epidural ◽  
Blockade Level

CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

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