scholarly journals Optimization of postoperative analgesia after adenoidectomy in children

2017 ◽  
Vol 8 (2) ◽  
pp. 277-282
Author(s):  
M. A. Georgiyants ◽  
M. B. Pushkar ◽  
O. V. Vysotska ◽  
A. P. Porvan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Analgesia ◽  
Group Iii ◽  
Group I ◽  
Pain Scales ◽  
Group Ii ◽  
Fentanyl Group

It is known that pharyngalgia is very common after tonsillectomy. It should be emphasized that the intensity of pain after adenoidectomy in children is not less important than after adenotonsillectomy. Despite the availability of standardized pain assessment scales and existing postoperative analgesia recommendations, unresolved postoperative pain still occurs in children. The research included 117 children with an average age of 7.5 ± 0.4 years, who underwent adenoidectomy at the Department of Anesthesiology and Intensive Care of "Regional Children’s Clinical Hospital" of Kharkov city in 2014. Depending on the method of general anesthesia, patients were divided into 3 groups: group I (n = 41) those who received propofol in combination with fentanyl; group II (n = 40) those who received sevoflurane in combination with fentanyl; group III (n = 36) those who received thiopental sodium combined with fentanyl. We monitored the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, BIS-index, heart rate variability, respiration rate, and SpO2. We determined the levels of cortisol and insulin in the blood serum, glucose level, the ratio of cortisol/insulin was calculated. Assessment of the efficiency of postoperative analgesia was performed using the Wong-Baker FACES Pain Scale («Faces») and the Oucher Scale. The result of analysis of the intensity of postoperative pain determined that at the 1st hour after the operation by the «Faces» and Oucher scales, it was significantly higher in patients of group II compared with the patients of group I and group III. The morning after the operation there was no significant difference in the pain scales, and the number of scale points showed that children from all groups did not have pain. According to the data of ANOVA it was determined that only the patients in group I with indicator ΔBIS-index «intubation – traumatic moment of operation» experienced postoperative pain intensity on the «Faces» scale. A very strong correlation between «cortisol – BIS index» was observed during the traumatic moment of operation and unidirectional positive correlations were seen both between ΔBIS-index «intubation-the traumatic moment of operation» and between the level of cortisolemia (Δcortisol before surgery – the traumatic moment of operation, Δcortisol extubation – the 1st day after the surgery and Δcortisol before surgery – the 1st day after the surgery) and the intensity of postoperative pain by the «Faces» and Oucher scales. The around-the-clock prescribed administration of ibuprofen at dose 10 mg/kg after adenoidectomy provided effective postoperative analgesia. At the 1st hour after the operation lower pain intensity was revealed in patients using propofol in combination with fentanyl by both pain scales. We believe that propofol is able to influence the level of cortisol and assume that due to minimal changes in the level of cortisol during the perioperative period, propofol can reduce the intensity of postoperative pain. 

scholarly journals THE SUCCESS OF HEART RATE VARIABILITY BIOFEEDBACK PARAMETERS IN PERSONS WITH DIFFERENT LEVELS OF BLOOD PRESSURE

2013 ◽  
Vol 68 (7) ◽  
pp. 20-23
Author(s):  
L. V. Poskotinova ◽  
D. B. Demin ◽  
E. V. Krivonogova ◽  
M. N. Dieva ◽  
N. M. Khasanova
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Antihypertensive Drugs ◽  
Heart Rhythm ◽  
Total Power ◽  
Heart Rate Variability Biofeedback ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Objective. The aim was to determine the nature of cardiovascular reactions during a single session of heart rate variability (HRV) biofeedback in order to increase vagal effects on heart rhythm in patients with different initial levels of blood pressure (BP). Participants and methods. 33 people with normal blood pressure (group I), 20 people with uncorrected arterial hypertension (AH) grade 1-2 (group II) and 22 people with AH grade 1-2 taking antihypertensive drugs (group III) were observed. The parameters of heart rate variability (HRV), BP and pulse oximetry in the initial stage, during a single HRV biofeedback session and after this session in order to increase the total power of the HRV spectrum (each stage was 5 min). Results. In patients of group II low success of HRV biofeedback session, a high sympathetic reactivity and reduced oxygen blood saturation were determined. A reactivity of vagal mechanism is more pronounced in persons of group III than in those of group II. It is reflected in a significant increase in their total power of the HRV spectrum compared to the initial values and in uptrend saturation levels during the biofeedback session. Conclusions. The ability to HRV biofeedback in order to increase the total power of the HRV spectrum for standard short recording (5 min) can be seen as a test to determine the safety reserves of vagal autonomic cardiovascular regulation in persons with increased blood pressure. 

scholarly journals Comparison of Ropivacaine-Fentanyl with Bupivacaine-Fentanyl for Labour Epidural Analgesia

2020 ◽  
Vol 14 (1) ◽  
pp. 108-114
Author(s):  
Kalpana Kulkarni ◽  
Rahul Patil
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Epidural Analgesia ◽  
Diastolic Blood Pressure ◽  
Diastolic Pressure ◽  
Vas Score ◽  
Group I ◽  
Significant Difference ◽  
Labour Epidural Analgesia ◽  
Group Ii

Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

scholarly journals Fentanyl Pretreatment Modifies Anaesthetic Induction with Etomidate

1988 ◽  
Vol 16 (2) ◽  
pp. 171-176 ◽  
Author(s):  
R. J. Stockham ◽  
T. H. Stanley ◽  
N. L. Pace ◽  
S. Gillmor ◽  
F. Groen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Side Effects ◽  
Linear Regression ◽  
Anaesthetic Induction ◽  
Arterial Blood ◽  
Group I ◽  
Haemodynamic Changes ◽  
Induction Of Anaesthesia ◽  
Fentanyl Group

Haemodynamic changes and side-effects of induction of anaesthesia with etomidate were evaluated in 60 ASA Class I or II patients. The objective was to find an optimal pre-induction dose of fentanyl which eliminated haemodynamic changes and side-effects during induction and intubation without introducing other problems. Patients were randomly assigned to four groups according to the pretreatment dose of fentanyl (Group I= 2 ml normal saline; Group II= 100 μg of fentanyl; Group III= 250μg of fentanyl; Group IV = 500 μg of fentanyl) administered intravenously five minutes prior to induction of anaesthesia with etomidate, 0.3 mg/kg. There was an increasing incidence of apnoea (53, 87, 87 and 100% in Groups I-IV respectively) and a decreasing incidence of myoclonus (60, 33, 13 and 0% in Groups I-IV respectively) and injection pain (53, 13, 7 and 0% in Groups I-IV respectively), P< 0.002 chi-square test for linear trends, with increasing fentanyl dosage. The incidences of postoperative nausea and vomiting were similar in the four groups. There were also significant linear regression relationships (P< 0.01 ANOVA for linear regression) between increasing doses of fentanyl administered before etomidate and the prevention of increases in systolic blood pressure and heart rate during the induction-intubation sequence. The data demonstrate that increasing pre-induction doses of fentanyl are more effective at minimising side-effects and preventing increases in systolic arterial blood pressure and heart rate but also increase the incidence of apnoea during induction. The results suggest that 500 μg of fentanyl is an ideal pretreatment dose in fit patients prior to anaesthetic induction with etomidate.

Spectrum of orthostatic disorders: Classification based on an analysis of the short-term circulatory response upon standing

1991 ◽  
Vol 81 (2) ◽  
pp. 241-248 ◽  
Author(s):  
W. Wieling ◽  
A. D. J. ten Harkel ◽  
J. J. van Lieshout
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Steady State ◽  
Maximum Heart Rate ◽  
Circulatory Response ◽  
Group Iii ◽  
Additional Information ◽  
Postural Tachycardia ◽  
Group I ◽  
Circulatory Control

1. In 31 consecutively referred patients (20 females, 11 males) with overt or suspected orthostatic disorders, the changes in blood pressure and heart rate that occur in the first 2 min of standing were analysed. 2. Blood pressure was measured continuously by Finapres. The blood pressure and heart rate responses after 1–2 min of standing (early steady-state response) were used to classify the patients as follows: group I (n = 17, age 42 ± 17 years), normal early steady-state blood pressure and heart rate responses; group II (n = 5, age 40 ± 14 years), combination of normal early steady-state blood pressure and postural tachycardia; group III (n = 9, age 51 ± 14 years), hypotensive orthostatic response with (4/9) or without (5/9) postural tachycardia. We examined whether additional information could be obtained by beat-to-beat analysis of the initial circulatory response (first 30 s). It was quantified by identifying the blood pressure trough and overshoot and the maximum heart rate and relative bradycardia. 3. The initial drop in systolic and diastolic blood pressures did not differ between the three groups. A recovery of blood pressure with a systolic and/or diastolic blood pressure overshoot was present in all group I and II patients, but was absent in all except two patients in group III. The initial maximum heart rate increase did not differ between the three groups. The relative bradycardia was less in groups II and III than in group I. 4. We conclude that analysis of the beat-to-beat blood pressure changes in the first 30 s after the onset of standing provides almost all the information that is necessary to determine abnormalities in orthostatic circulatory control.

scholarly journals A Comparative Study of Bisoprolol with Carvedilol on LV Systolic Function in Patients with Chronic Heart Failure

2018 ◽  
Vol 14 (1) ◽  
pp. 3-8
Author(s):  
Mohammad Ashraf Hossain ◽  
Khurshed Ahmed ◽  
Md Faisal Ibn Kabir ◽  
Md Fakhrul Islam Khaled ◽  
Rakibul H Rashed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Group I ◽  
End Systolic Volume ◽  
Group Ii

Background: Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (3.2±0.1 in group I versus 2.3±0.5 in group II; P<0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p>0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8

Abstract P147: Office Blood Pressure: An Inadequate Guide to the Diagnosis and Treatment of Hypertension

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Jay Cohn ◽  
Sue Duval ◽  
Natalia Florea ◽  
Lynn Hoke ◽  
Daniel Duprez
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Invasive Disease ◽  
Office Blood Pressure ◽  
Group Iii ◽  
Non Invasive ◽  
Group I ◽  
Group Ii ◽  
Cv Disease ◽  
Asymptomatic Individuals

Hypertension is a cardiovascular (CV) disease with high risk for CV morbid events (ME) that benefits from anti-hypertensive therapy. Resting blood pressure (BP) >140/90 mmHg serves as the diagnostic criterion for hypertension, and management has been aimed at BP reduction. Progression of CV disease in the absence of elevated blood pressure identifies individuals who might benefit from CV-protective therapy but are not currently being recognized as in need of treatment. In 2017 asymptomatic individuals evaluated for early functional and structural CV abnormalities, 1534 not taking anti-hypertensive drugs were available to determine the relationship between office blood pressure and the severity of CV abnormalities, as defined by a 10-test non-invasive disease score (DS) of 0-20. Previous studies have documented the high predictive value of DS for future CVME. The population was 53% male, average age 50±11 years, BP 122/77mmHg, LDL cholesterol 129±38 mg/dL, HDL 52±17mg/dL, triglycerides 109 mg/dL. DS was adjusted by eliminating the score for BP, but 9-test DS was still directly related to BP: 2.3 in those (n=550) <120/80 mmHg (Group I), 3.2 in those 120-129/80-85 mmHg (n=600) (Group II), 4.1 in those 130-139/85-89 mmHg (n=236) (Group III), and 5.7 in those 140+/90+mmHg (n=148) (Group IV). Nonetheless, DS of >6 indicative of high risk was present in 10% of Group I, 20% of Group II and 30% of Group III. BP was largely overlapping in individuals with no CV disease (DS 0-2), early disease (DS 3-5) and advanced disease (DS 6+). Therefore, reliance on resting BP leaves many at-risk individuals undiagnosed and untreated for early CV disease likely to progress. The hypertensive state exists in the absence of elevated BP and should be recognized and treated to prevent CVME.

Comparative study between paracetamol versus paracetamol and pregabalin combination for postoperative analgesia in hip surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A R M Hassab ◽  
H M Fawzy ◽  
S M Elfawal ◽  
D M Kamaleldin
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Demographic Data ◽  
Preoperative Assessment ◽  
Multimodal Analgesia ◽  
Blurred Vision ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

Abstract Introduction Pregabalin has been used for treatment of chronic pain, but recently it has been introduced in treatment of acute postoperative pain. Aim of Study This study is conducted to evaluate the postoperative analgesic effect of paracetamol and pregabalin combination versus paracetamol after hip surgeries. Methods The study was done on 20 randomly chosen patients after approval of the medical ethical committee of Ain Shams University. Patients were divided randomly into two groups, each group consisted of 10 patients.After preoperative assessment and obtaining baseline vital data all patients received spinal anaesthesia. Group I received paracetamol 1gm intravenous immediately postoperatively and every 6 hours for 24 hours. Group II received the same as group I plus two doses of oral pregabalin 300mg in the recovery room and 12 hours later. The two groups were assessed postoperatively and they were compared regarding demographic data, postoperative pain control, sedation, total pethidine consumption, hemodynamics and side effects. Results In pregabalin group (group II), pain scores and total pethidine consumption were significantly lower and sedation scores were higher than group II. Heart rate and arterial blood pressure were lower in group II but without clinical significance. Conclusions This study revealed that combination of paracetamol and pregabalin as multimodal analgesia is better than paracetamol alone in postoperative analgesia, and decreasing use of opioids without significant effect on hemodynamics but with increased incidence of side effects such as somnolence, dizziness and blurred vision.

Attenuation of Cardiovascular Response During Laryngoscopy and Endotracheal Intubation by Using Pethidine with Lignocaine

1970 ◽  
Vol 6 (2) ◽  
pp. 40-43 ◽  
Author(s):  
MT Mollick ◽  
MD Hossain ◽  
NP Ali
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Cardiovascular Response ◽  
Rate Pressure Product ◽  
Group I ◽  
Blood Pressures ◽  
Group Ii

A prospective comparative study was done on lignocaine versus lignocaine with pethidine to observe the effect on cardiovascular response to laryngoscopy and endotracheal intubation. One hundred such elective surgical patients of active age group (16 - 60 years) having American Society of Anaesthesiologist (ASA) physical status I & II irrespective of surgical procedure were randomly assigned to one of the two groups of 50 each. Group I received injection lignocaine 1 mg/kg intravenously 02 minutes before induction of general anaesthesia. Patients in group II received injection pethidine 1 mg/kg body weight and injection lignocaine 1 mg/kg body weight intravenously 02 minutes before induction of general anaesthesia. Haemodynamic parameter i.e. blood pressures (systolic blood pressure, diastolic blood pressure and mean blood pressure), heart rate, rate pressure product were monitored after 1st, 3rd, 5th minutes following intubation. There were statistically significant (p<0.001) increase in blood pressures, heart rate and rate pressure product in group I i.e. pretreatment with 1 mg/kg body weight intravenous lignocaine and remained so after 5 minutes. On the other hand there were no statistically significant (p>0.05) increase in heart rate, blood pressures and rate pressure product in group II, where pretreatment done with pethidine 1 mg/kg body weight with lignocaine 1 mg/kg body weight and the values returned control level before 5 minutes. The study showed that pethidine 1 mg/kg body weight with lignocaine 1 mg/kg body weight pretreatment suppresses the cardiovascular response due to laryngoscopy and intubation. Key words: Cardiovascular response; laryngoscopy; lignocaine with pethidine. DOI: 10.3329/jafmc.v6i2.7274JAFMC Bangladesh. Vol 6, No 2 (December) 2010 pp.40-43

scholarly journals Comparative Study between Adductor Canal Block, Femoral Nerve Block and Epidural Analgesia for Management of Post-Operative Pain in Total Knee Replacement

2021 ◽  
pp. 177-188
Author(s):  
Heba Salah Eldin Ismail Gawish ◽  
Amr Arafa Mohammed Elbadry ◽  
Nagat Sayed Mohammed El-Shmaa ◽  
Abdelraheem Mostafa Dowidar
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Femoral Nerve ◽  
Group Iii ◽  
Insignificant Change ◽  
Adductor Canal ◽  
Arterial Blood ◽  
Group I ◽  
Total Knee ◽  
Group Ii

Background: Total knee arthroplasty (TKA) is a common surgery that is associated with moderate to severe pain. Early ambulation and physical therapy are essential for functional recovery and long-term functional outcome after TKA as well as for reducing the immobility related complications. Hence, optimal pain relief while maintaining the motor function remains the mainstay in postoperative pain management after TKA. ‎Patients and Methods: This prospective randomized controlled open-labelled study was carried out at Tanta University Hospital, Orthopedic Surgery Department from January 2020 to February 2021. Results: Heart rate was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and there was insignificant change between group I and group II. Mean arterial blood pressure was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.NRS was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II. Patient satisfaction was significantly higher in group III compared to group I and group II on the second postoperative day. Conclusion: Adductor canal nerve block provide better postoperative pain relieve with lower NRS after TKA than femoral and epidural blocks. It provides more stability of hemodynamic parameter and longer time for the 1st time of analgesic request. Also, total consumption of morphine in 1st postoperative day is lower than femoral and epidural blocks.

scholarly journals Study of morphine with ropivacaine and ropivacaine alone for caudal epidural analgesia in children

2020 ◽  
Vol 7 (3) ◽  
pp. 781
Author(s):  
Saidingpuii Sailo ◽  
Micky Zodinpuia ◽  
Naveen P.
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Pediatric Anesthesia ◽  
Epidural Block ◽  
Group I ◽  
Safe Technique ◽  
Group Ii ◽  
Caudal Epidural

Background: Caudal epidural analgesia is one of the most popular and commonly performed regional blocks in pediatric anesthesia. It is reliable and safe technique that can be used with general anesthesia for intraoperative and postoperative analgesia. The aim of this research is to study the effect of morphine (15 µg/kg) with ropivacaine (0.2%) and ropivacaine (0.2%) alone through caudal epidural route on duration of analgesia in children.Methods: The study was performed on 60 ASA grade I and II patients, aged 1 to 7 years scheduled for elective infraumbilical surgeries. After induction of general anesthesia, caudal epidural block was performed. Each group consisted of 30 pediatric patients: group I-caudal epidural 0.2% ropivacaine (1 ml/kg) and group II- caudal epidural 0.2% ropivacaine (1 ml/kg) with morphine 15 µg/kg. Intra-operatively heart rate, blood pressure was recorded at pre-induction, immediately after induction, 5 minutes after administration of caudal block and thereafter every 10 minutes till the completion of surgery. Postoperative heart rate, blood pressure, pain score was assessed periodically till 24th hour.Results: The duration of analgesia was more in group II (7.30±1.78 hour) in comparison to group I (3.93±0.83 hour). The fall in mean arterial pressure and heart rate were not significant in group II as compared to group I.Conclusions: Addition of low dose morphine to ropivacaine resulted in prolonging the duration of analgesia by almost double the duration as compared to ropivacaine alone.

Sign in / Sign up

Export Citation Format

Share Document