scholarly journals A comparative study between intraoperativelow-dose ketamine and dexmedetomidine, as an anaesthetic adjuvant in lumbar spine instrumentation surgery for the post-operative analgesic requirement

2017 ◽  
Vol 04 (02) ◽  
pp. 091-098 ◽  
Author(s):  
Ranadhir Mitra ◽  
Hemanshu Prabhakar ◽  
Girija Rath ◽  
Parmod Bithal ◽  
Ankur Khandelwal
Keyword(s):  
Lumbar Spine ◽  
Hospital Stay ◽  
Spinal Instrumentation ◽  
Visual Analog Scale Score ◽  
Analgesic Requirement ◽  
Comparable Group ◽  
Treatment Regimens ◽  
Spine Instrumentation ◽  
Inhalational Agent ◽  
Group D

Abstract Background: Spinal instrumentation and fusion surgery presents the anaesthesiologist with multiple issues like intraoperative blood loss, hemodynamic changes, prolonged surgery etc, but the most probing aspect is analgesia. While both ketamine and dexmedetomidine as adjuvants have shown to decrease intraoperative anaesthetics and post operative analgesic consumption but there are no comparative studies. The primary aim of this study was comparison of post-operative analgesic requirements for 1st 24 hours after surgery when either of the drugs was used as adjuvants. Methods: Adult patients aged 18-60 years, of either sex, and ASA status I or II scheduled for elective lumbar spine instrumentation (of 2 or more spinal levels) surgery were enrolled for the study. Patients were randomised into one of the 3 treatment regimens ketamine/group K (0.5mg/kg bolus followed by 250 mcg/kg/h infusion), dexmedetomidine/ group D (0.5mcg/kg bolus followed by 0.5 mcg/kg/h infusion) or the placebo/ group S (saline/placebo). The study drugs were started after turning the patient prone. Data were recorded for intraoperative hemodynamics, anesthetic consumption (inhalational agent and opioids), emergence through RAS scale (Riker sedation agitation scale), PCA (patient controlled analgesia)-fentanyl use and VAS (visual analog scale) score in the 1st 24 hours after surgery. Appropriate statistical analysis was done. Results: A total of 42 patients (14 in each group) were enrolled. The total PCA fentanyl consumed in first 24 hours of surgery was maximum with the group-S (1366.6±382.6 mcg) in compared with group- D (1035.4±391.8 mcg) and group- K (1164.9±503.6 mcg) (P=0.13). The post extubation RAS score was lower in group-K (3.7±0.6) when compared with group-D (4±0.4) and group-S (4.5±0.9) (P=.009). Total intraoperative sevoflurane and fentanyl consumption showed no difference (P=0.19 and P=0.28). VAS score at rest was higher at baseline with group-S (P=0.009). The ICU stay was comparable (group-D: 1.4±0.5 d, group-K: 1.5±0.5 d, group-S: 1.9±0.5 d) among the groups. Hospital stay was also comparable (P=0.09). Conclusion: In patients undergoing lumbar instrumentation surgery, opioid consumption, VAS scores, PCA pump bad demands, inhalational agent consumption, hospital stay were comparable when either ketamine or dexmedetomidine was used as intraoperative anesthetic adjuvants.

scholarly journals Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
Avani Vaishnav ◽  
Joseph Barbera ◽  
Hiroshi Kumagai ◽  
James Dowdell ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
Percutaneous Pedicle Screw ◽  
Spine Instrumentation ◽  
Surgical Methods

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

“A COMPARATIVE STUDY TO EVALUATE THE EFFICACY OF DULOXETINE IN POSTOPERATIVE PAIN RELIEF IN PATIENTS IN UNDERGOING LUMBAR SPINE SURGERY ”

2021 ◽  
pp. 76-77
Author(s):  
Deepti Chauhan ◽  
Satyendra Yadav ◽  
Heena Sheikh ◽  
Ashish Mathur
Keyword(s):  
Lumbar Spine ◽  
Postoperative Pain ◽  
Pain Relief ◽  
General Anaesthesia ◽  
Spine Surgery ◽  
Postoperative Pain Relief ◽  
Lumbar Spine Surgery ◽  
Analgesic Requirement ◽  
Respiratory Parameters ◽  
Result Analysis

AIMS AND OBJECTIVES: To evaluate the efcacy of duloxetine in different doses in postoperative pain relief in patients undergoing lumbar spine surgery. MATERIALAND METHOD: 80 patients of ASA grade І & ІІ of either sex scheduled for lumbar spine surgery under general anaesthesia were divided into 2 groups (n=40 each) randomly.Group D (n=40) Patients who received a 60 mg duloxetine 1 hour before surgery and another tablet the following morning. Group 'P'(n=40) Patients who received a placebo tablet 1 hour before surgery and again the following morning. Pulse rate, blood pressure, respiratory rate and severity of pain on NRS scale was noted at 0 hr, 4 hr, 8 hr, 12 hr, 16 hr, 20 hr, 24 hr, 28 hr, 32 hr and 48 hr after surgery. And the presence or absence of adverse effects, such as headache, nausea, vomiting, dizziness, and drowsiness were noted. RESULT: Analysis revealed that time for rst analgesic requirement was signicantly longer with oral Duloxetine 60 mg than with placebo. Pre-emptive oral Duloxetine 60 mg decreases the severity of pain postoperatively but not signicantly as compared to placebo in patients posted for lumbar spine surgery under general anaesthesia. Oral Duloxetine 60 mg had no signicant effect on cardiovascular and respiratory parameters. Patients receiving duloxetine had higher incidence of nausea, vomiting. CONCLUSION:that time for rst analgesic requirement was signicantly longer with oral Duloxetine 60 mg than placebo.

scholarly journals Pooperacinis skausmo malšinimas deksametazonu po laparoskopinių gaubtinės žarnos operacijų

2012 ◽  
Vol 10 (1-2) ◽  
pp. 0-0
Author(s):  
Povilas Miliauskas ◽  
Renatas Tikuišis ◽  
Narimantas Evaldas Samalavičius ◽  
Aleksas Žurauskas
Keyword(s):  
Visual Analog Scale Score ◽  
Colon Surgery ◽  
Anesthetic Technique ◽  
Anesthesia Induction ◽  
Opioid Use ◽  
Analgesic Requirement ◽  
Analgesic Effects ◽  
Medicine Clinic ◽  
Laparoscopic Colon Surgery ◽  
Laparoscopic Colon

Povilas Miliauskas1, Renatas Tikuišis1, Narimantas Evaldas Samalavičius2, Aleksas Žurauskas1 1Vilniaus universiteto Onkologijos instituto Chirurgijos klinika, Santariškių g. 1, LT-08660 Vilnius2Vilniaus universiteto Medicinos fakulteto Anesteziologijos ir Reanimatologijos klinika, Šiltnamių g. 29, LT-04130 Vilnus3Vilniaus universiteto Medicinos fakulteto Vidaus ligų, šeimos medicinos ir onkologijos klinika, Santariškių g. 2, LT-08661 Vilnius El. paštas: [email protected] Įvadas / tikslas Deksametazonas pasižymi pykinimą slopinančiomis ir skausmą malšinančiomis savybėmis atliekant įvairias operacijas. Optimali deksametazono dozė, malšinant skausmą po laparoskopinių operacijų, tiksliai nežinoma. Šio darbo tikslas – nustatyti skausmą malšinančią deksametazono dozę po laparoskopinių gaubtinės žarnos operacijų. Ligoniai ir metodai Į tyrimą buvo įtraukta 60 ligonių, kuriems atliktos laparoskopinės gaubtinės žarnos operacijos. Atsitiktinės atrankos būdu jie suskirstyti į keturias grupes, atsižvelgiant į deksametazono dozę: D0 grupę sudarė kontrolinės grupės pacientai, kuriems nebuvo skirto deksametazono, D4, D8, ir D12 – tiriamųjų grupių pacientai, kuriems buvo sušvirkšta atitinkamai 4 mg, 8 mg, ir 12 mg deksametazono tirpalo į veną anestezijos indukcijos metu. Visų grupių pacientams buvo taikyta tokia pati bendroji nejautra. Pirmas 24 val. po operacijos skausmo intensyvumą vertinome pagal vizualinę analoginę skalę ir suvartotų analgetikų kiekį. Rezultatai Pirmą parą po operacijos suvartota ketolgano, paracetamolio ir tramadolio dozė buvo mažesnė D8 ir D12 grupių pacientų, palyginti su D0 ir D4 grupių pacientais. Analgetikų suvartojimas D0 ir D4 grupių pacientų buvo vienodas. Pavartojus didesnę deksametazono dozę D12 grupės pacientams negu D8 grupės pacientams, didesnio skausmo malšinamojo poveikio nenustatyta. Išvada Deksametazono 8 mg dozė anestezijos indukcijos metu malšina pooperacinį skausmą ir sumažina analgetikų poreikį pirmą parą po laparoskopinių gaubtinės žarnos operacijų. Reikšminiai žodžiai: pooperacinis skausmo malšinimas, deksametazonas, laparoskopinės operacijos Postoperative reduction pain with dexamethasone after laparoscopic colon surgery Povilas Miliauskas1, Renatas Tikuišis1, Narimantas Evaldas Samalavičius2,Renatas Tikuišis1,2, Povilas Miliauskas1, Narimantas Evaldas Samalavičius1,3, Aleksas Žurauskas11Vilnius University, Institute of Oncology, Santariškių Str. 1, LT-08660 Vilnius, Lithuania2Vilnius University, Faculty of Medicine, Clinic of Anesthesiology and Intensive Care, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania3Vilnius Uuniversity, Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Santariškių Str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / Objective Dexamethasone has antiemetic and analgesic effects in various types of surgery. The optimal doses of dexamethasone in the management of pain after laparoscopic surgery are not well defined. The purpose of this study was to evaluate the dose-dependent analgesic effects of dexamethasone after laparoscopic colon surgery. Patients and methods Sixty patients after laparoscopic colon surgery were included in the study. The patients were randomized to receive saline (group D0), dexamethasone 4 mg (group D4), 8 mg (group D8) and 12 mg (group D12) intravenously during the induction of anesthesia. The same anesthetic technique was used to all these patients. The visual analog scale score for pain and the amounts of the analgesics were recoded 24 h after surgery. Results The total doses of ketolgan, paracetamol and tramadol in the first 24 hours postoperatively were smaller in the D8 and D12 groups than in the D0 and D4 groups (p < 0.05). No difference in analgesic requirement was found between the D0 and D4 groups. No increase in the analgesic effectiveness or reduction of opioid use could be demonstrated in the D8 and D12 groups. Conclusion Intravenous dexamethasone (8 mg) during anesthesia induction is effective in reducing analgesic requirement during the first postoperative day after laparoscopic colon surgery. Key words: postoperative analgesia, dexamethasone, laparoscopic colectomy

Evaluation of the effectiveness of vacuum-assisted closure in the treatment of Fournier gangrene

2021 ◽  
pp. 1
Keyword(s):  
Hospital Stay ◽  
Wound Closure ◽  
Length Of Hospital Stay ◽  
Vacuum Assisted Closure ◽  
Analgesic Requirement ◽  
Vac Therapy ◽  
Fournier Gangrene ◽  
Group I ◽  
Group Ii ◽  
Closure Method

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.

Nonfusion stabilization of the degenerative lumbar spine

2011 ◽  
Vol 15 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Alberto Maleci ◽  
Rafael Donatus Sambale ◽  
Michele Schiavone ◽  
Franz Lamp ◽  
Fahir Özer ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Donor Site ◽  
Visual Analog Scale Score ◽  
Clinical Results ◽  
Degenerative Disease ◽  
Operative Trauma ◽  
Implant Complications ◽  
Rod System ◽  
Adjacent Disc

Object The goal of this study was to assess whether a stable but nonrigid nonfusion implant can stabilize the spine in degenerative diseases and also prevent instability following decompression. Instrumented spondylodesis is a recognized surgical treatment in degenerative disease of the lumbar spine. However, pain can develop at the bone graft donor site and the operative trauma can be very stressful in elderly patients, and it is suspected that there may be increased degenerative changes in the adjacent segments. In 2002, a nonrigid but rotationally stable pedicle screw and rod system was introduced, which could be used without additional fusion (referred to hereafter as the Cosmic system). Methods A total of 139 patients with degenerative disease of the lumbar spine underwent spinal stabilization with the Cosmic system without additional spondylodesis. Seventy patients had an additional decompression. The minimum follow-up was 2 years. The perioperative course, the clinical results, and the erect anteroposterior and lateral radiographs were recorded and compared with the preoperative data. The data were obtained from 6 different spine centers in Europe and documented on an Internet platform. Results The Oswestry Disability Index score improved from 48.9% to 22.5%, and the visual analog scale score decreased from 7.3 to 2.5. Lumbar lordosis did not change, nor did the adjacent disc height. Eleven patients underwent revision, 4 of them for implant failure. Of the 139 patients, 110 assessed the result as excellent, very good, or good; 24 as fair; and 5 as poor. A total of 122 patients would undergo surgery again. There were no significant differences between patients with or without an additional decompression. Conclusions The Cosmic system is a stable but nonrigid posterior nonfusion system. Implant complications are low and the clinical outcome is good. Longer follow-up is necessary to confirm the 2-year results.

scholarly journals Biomechanical Study of Cortical Bone Trajectory Screws in Intervertebral Fixation of Lumbar Tuberculosis

2021 ◽  
Author(s):  
Chen-Wei Zhang ◽  
Shi-Yuan Shi ◽  
De-Xin Hu ◽  
Shen-Ping Hu ◽  
Jin-Ping Hu ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Internal Fixation ◽  
Bone Graft ◽  
Lateral Bending ◽  
Flexion Extension ◽  
Group A ◽  
Group B ◽  
Group D ◽  
State 1 ◽  
Screw Group

Abstract BackgroundWe aimed to explore the biomechanical stability and advantages of cortical bone trajectory (CBT) screws in the treatment of lumbar spine tuberculosis and provide biomechanical basis for the choice of clinical fixation methods. Methods16 pig spine specimens (T12-L5) were selected to simulate the lumbar spine(L2-L3) tuberculosis bone destruction model in vitro. The 16 specimens were randomly divided into 4 groups, and short segments (pedicle screws of the diseased vertebrae) were assigned respectively. Fixation (group A), short-segment fixation (group B), fixation with pedicle screw (group C), fixation with CBT screw (group D), 4 specimens in each group , Each specimen in each group was subjected to biomechanical testing in the state of complete specimen (state 1) and L2-3 spinal tuberculosis model bone graft fusion and internal fixation (state 2). Load each specimen on the spine 3D exercise machine, respectively apply moments of 2N·m, 2.5N·m, 1N·m, 3N·m, meanwhile record the movement of the specimens in the four directions of flexion，extension，lateral bending and torsion ROM, compare Simultaneously analyze each group of ROM. ResultsThe ROMs of flexion, extension, lateral bending, and torsion in group A in state 1 and state 3 modes were （8.47±1.76）°、 （7.01±1.10）°、 （5.03±0.92）°、 （4.48±0.41）°and （4.78±0.07）°、 （2.91±0.16）°、 （2.66±0.09）°、 （2.23±0.05）°; the ROMs of flexion, extension, lateral bending and torsion in group B in state 1 and state 3 modes were （7.32±0.75）°、 （5.35±0.69）°、 （3.44±0.51）°、 （3.36±1.02）°and（3.51±0.29）°、 （1.74±0.04）°、 （1.53±0.31）°、 （1.23±0.08）°; The ROMs of flexion, extension, lateral bending, and torsion in group C in state 1 and state 3 modes were （10.01±0.39）°、 （9.05±0.25）°、 （7.42±1.06）°、 （6.92±1.15）°and （7.21±0.17）°、 （5.07±0.02）°、 （5.12±0.74）°、 （4.58±0.01）°; The ROMs of flexion, extension, lateral bending, and torsion in group D in state 1 and state 3 modes were （9.20±1.37）°、 （7.38±0.88）°、 （6.89±1.22）°、 （6.00±0.52）°and （6.06±0.16）°、 （3.99±0.02）°、 （3.85±0.08）°、 （3.47±0.10）°. The ROM value of each fixed mode group under the state of bone graft fusion and internal fixation was lower than that of the intact state, and the difference was statistically significant (P<0.05)，The t values are 4.531, 5.346, 6.008, 4.149; 9.481, 16.181, 11.814, 4.769; 4.349, 8.002, 4.473, 4.800; 5.041, 4.146, 12.232, 10.58. ConclusionCBT screw disease intervertebral fixation can not only provide sufficient mechanical stability, but also provide stronger stability when using the same fixed segment, and The fixed segments are minimized.

scholarly journals Study on outcome of laparoscopic donor nephrectomy

2017 ◽  
Vol 4 (8) ◽  
pp. 2811
Author(s):  
Subha Kanesh S. K. ◽  
Govindarajan P.
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operating Time ◽  
Donor Nephrectomy ◽  
Laparoscopic Donor Nephrectomy ◽  
Analgesic Requirement ◽  
Ischemic Time ◽  
Medical College ◽  
Duration Of Hospital Stay ◽  
The Mean

Background: Laparoscopic donor nephrectomy is being performed in increasing numbers since 1995. Now laparoscopic donor nephrectomy has been accepted as good alternate to open procedure as seen in various other abdominal surgeries. This was the basis of the present study. So, the present study was designed to analyse and compare the outcome of Laparoscopic donor nephrectomy and Open donor nephrectomies.Methods: The prospective and observational study was conducted at Stanley Medical College in Department of Urology in 61 Patients aged between 25-50 years who underwent left donor nephrectomy The Mean operating time, warm ischemic time, blood loss, analgesic requirement and duration of hospital stay were recorded and analysed statistically.Results: Out of 61 donor nephrectomies, 16 kidneys harvested by laparoscopic method with only 2 (12%) conversion to open due bleeding. Mean operating time was 179.9±47.6 minutes. Present study showed mean blood loss of (163±93 ml). Analgesic requirement of the LDN (mean 1.25 days) was significantly lower when compared to open group (mean 3.75 days). The present study shows duration of hospital stay was lower in LDN (mean 5.1days).Conclusions: Laparoscopic donor nephrectomy is an effective, safe and rewarding though it is time consuming and technically challenging. The analgesic requirement, duration of hospital stay and the blood loss were less with the laparoscopic surgery. Results of graft functioning of kidneys in both procedures were equivalent. So laparoscopic donor nephrectomy can be made as the procedure of choice in future.

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