Background: Patient controlled epidural analgesia has been associated with marked maternal satisfaction. Combination of local anesthetics with various adjuvants have been tried to ensure optimum analgesia with no or negligible fetomaternal side effects. Aim: To compare fentanyl, clonidine or dexmedetomidine as adjuvants with ropivacaine for labor epidural analgesia (LEA) using a PCEA pump with the objective to assess fetomaternal outcome in terms of analgesic effect, success rate of vaginal delivery, complications, neonatal APGAR score and maternal satisfaction. Materials and methods: Sixty full term laboring women received 10 ml 0.2% ropivacaine followed by continuous infusion of 0.1% ropivacaine with 2 μg/ml of either dexmedetomidine, fentanyl or clonidine respectively in Groups A, B, and C at 6 ml/hr. demand bolus setting was 2 ml with a lock out interval of 15 minutes. At full cervical dilatation another 10 ml bolus of respective solution were given. Parturients were monitored at 0, 10, 20, 30 min after giving 1st epidural bolus dose and then at 30 min interval for ongoing labor for pain relief (VAS), motor blockade (Bromage score), progress of labor (duration of 1st stage and 2nd stage), mode of delivery, fetal APGAR score (at 1 min and 5 min), vitals (HR, NIBP, RR, SpO2), overall patient satisfaction and complications. The statistical analysis was done both qualitatively (Fisher-exact test/Chi-square test) and quantitatively (one-way analysis of variance test with post-hoc intergroup comparisons using Bonferroni’s correction). Results: Onset of pain relief was earlier in fentanyl group, however after 1 h all three groups showed comparable pain relief (P>0.05). There was a significant reduction in HR in group C and B compared to group A (P<0.001) and MAP in group C compared to groups A and B. The motor- blocking potency was slightly higher in dexmedetomidine group, however no significant motor weakness observed in any parturient. Mean demand bolus need was more in group C compared to A and B (P<0.001). There was no significant difference in mode of delivery (either SVD or cesarean) in between the groups. There was not a single case of fetal distress and most of the parturients showed satisfactory response to PCEA. Conclusion: All three study drugs produced equipotent analgesia in combination with ropivacaine 0.1%. There was absolute pain relief without significant motor blockade or any increase in instrumentation/cesarean deliveries or any adverse fetal outcomes.
{"title":"A comparison of fetomaternal outcome in PCEA using fentanyl, clonidine and dexmedetomidine as adjuvants with Ropivacaine in painless labor: a prospective, double blinded randomized study","authors":"A. Kumar, Reena","doi":"10.56126/71.2.4","DOIUrl":"https://doi.org/10.56126/71.2.4","url":null,"abstract":"Background: Patient controlled epidural analgesia has been associated with marked maternal satisfaction. Combination of local anesthetics with various adjuvants have been tried to ensure optimum analgesia with no or negligible fetomaternal side effects.\u0000\u0000Aim: To compare fentanyl, clonidine or dexmedetomidine as adjuvants with ropivacaine for labor epidural analgesia (LEA) using a PCEA pump with the objective to assess fetomaternal outcome in terms of analgesic effect, success rate of vaginal delivery, complications, neonatal APGAR score and maternal satisfaction.\u0000\u0000Materials and methods: Sixty full term laboring women received 10 ml 0.2% ropivacaine followed by continuous infusion of 0.1% ropivacaine with 2 μg/ml of either dexmedetomidine, fentanyl or clonidine respectively in Groups A, B, and C at 6 ml/hr. demand bolus setting was 2 ml with a lock out interval of 15 minutes. At full cervical dilatation another 10 ml bolus of respective solution were given. Parturients were monitored at 0, 10, 20, 30 min after giving 1st epidural bolus dose and then at 30 min interval for ongoing labor for pain relief (VAS), motor blockade (Bromage score), progress of labor (duration of 1st stage and 2nd stage), mode of delivery, fetal APGAR score (at 1 min and 5 min), vitals (HR, NIBP, RR, SpO2), overall patient satisfaction and complications. The statistical analysis was done both qualitatively (Fisher-exact test/Chi-square test) and quantitatively (one-way analysis of variance test with post-hoc intergroup comparisons using Bonferroni’s correction).\u0000\u0000Results: Onset of pain relief was earlier in fentanyl group, however after 1 h all three groups showed comparable pain relief (P>0.05). There was a significant reduction in HR in group C and B compared to group A (P<0.001) and MAP in group C compared to groups A and B. The motor- blocking potency was slightly higher in dexmedetomidine group, however no significant motor weakness observed in any parturient. Mean demand bolus need was more in group C compared to A and B (P<0.001). There was no significant difference in mode of delivery (either SVD or cesarean) in between the groups. There was not a single case of fetal distress and most of the parturients showed satisfactory response to PCEA.\u0000\u0000Conclusion: All three study drugs produced equipotent analgesia in combination with ropivacaine 0.1%. There was absolute pain relief without significant motor blockade or any increase in instrumentation/cesarean deliveries or any adverse fetal outcomes.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49027032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Knotting is a well-known but rare complication of the use of epidural catheters. We report the case of a knotted catheter successfully removed by simple traction, after determining its ultimate tensile strength. We reviewed the case reports published since 1979. We assessed the prevalence of this complication, the impact of placement technique on a knot’s occurrence, the value of the different imaging modalities, and the one of various techniques used for catheter removal. A knotted catheter can often be removed intact with steady and gentle traction. Before pulling on an entrapped catheter and to avoid breakage, it may be useful to assess its ultimate tensile strength on its free extremity or another identical catheter. Limiting the length of a catheter threaded in the epidural space during its insertion seems to be the best way to avoid knots.
{"title":"Knotted epidural catheter: the role of determining a catheter’s ultimate tensile strength before pulling on it. A case report and literature review","authors":"A. Orfi, P. Dewandre, J. Brichant","doi":"10.56126/71.2.7","DOIUrl":"https://doi.org/10.56126/71.2.7","url":null,"abstract":"Knotting is a well-known but rare complication of the use of epidural catheters. We report the case of a knotted catheter successfully removed by simple traction, after determining its ultimate tensile strength. We reviewed the case reports published since 1979. We assessed the prevalence of this complication, the impact of placement technique on a knot’s occurrence, the value of the different imaging modalities, and the one of various techniques used for catheter removal. A knotted catheter can often be removed intact with steady and gentle traction. Before pulling on an entrapped catheter and to avoid breakage, it may be useful to assess its ultimate tensile strength on its free extremity or another identical catheter. Limiting the length of a catheter threaded in the epidural space during its insertion seems to be the best way to avoid knots.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47620169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A direct laryngoscopy is currently the standard method for diagnosing RLN (Recurrent Laryngeal Nerve) paralysis after thyroid or parathyroid surgery but this procedure can be uncomfortable for patients and may cause undesirable changes in vital signs. A 40 years old female after a total thyroidectomy was assumed to have a bilateral vocal cord palsy on direct laryngoscopy after surgery. Patient was shifted to intensive care unit (ICU) on ventilatory support. We used serial transcutaneous laryngeal ultrasonography in the ICU for assessing the vocal cord functions along with conservative management. After 3 days, we were able to safely extubate the trachea and tracheostomy was avoided.
{"title":"Serial transcutaneous laryngeal ultrasonography in intensive care unit for assessment of vocal cord palsy: a case report","authors":"N. Kumar, A. Kumar","doi":"10.56126/71.2.6","DOIUrl":"https://doi.org/10.56126/71.2.6","url":null,"abstract":"A direct laryngoscopy is currently the standard method for diagnosing RLN (Recurrent Laryngeal Nerve) paralysis after thyroid or parathyroid surgery but this procedure can be uncomfortable for patients and may cause undesirable changes in vital signs. A 40 years old female after a total thyroidectomy was assumed to have a bilateral vocal cord palsy on direct laryngoscopy after surgery. Patient was shifted to intensive care unit (ICU) on ventilatory support. We used serial transcutaneous laryngeal ultrasonography in the ICU for assessing the vocal cord functions along with conservative management. After 3 days, we were able to safely extubate the trachea and tracheostomy was avoided.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44729167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Vernieuwe, P. Van de Putte, J. Deen, S. Bouchez
Point-of care ultrasound (PoCUS) is a new clinical diagnostic paradigm that plays an instrumental role in the ongoing anesthesiologist’s evolving role towards a perioperative physician. Currently, there are few approved curricula that incorporate a PoCUS program into anesthesia residency. This article examines relevant PoCUS applications for anesthesiologists, presents an overview of existing international guidelines for education and training, and reflects on the need for specialty-wide standards. We present a possible framework, that could offer a first move towards a structured PoCUS pathway for Belgian anesthesia residents and facilitate its incorporation into national anesthesia practice.
{"title":"Focus on PoCUS or hocus pocus? Integrating point-of-care ultrasound into residency and clinical practice","authors":"L. Vernieuwe, P. Van de Putte, J. Deen, S. Bouchez","doi":"10.56126/71.2.3","DOIUrl":"https://doi.org/10.56126/71.2.3","url":null,"abstract":"Point-of care ultrasound (PoCUS) is a new clinical diagnostic paradigm that plays an instrumental role in the ongoing anesthesiologist’s evolving role towards a perioperative physician. Currently, there are few approved curricula that incorporate a PoCUS program into anesthesia residency. This article examines relevant PoCUS applications for anesthesiologists, presents an overview of existing international guidelines for education and training, and reflects on the need for specialty-wide standards. We present a possible framework, that could offer a first move towards a structured PoCUS pathway for Belgian anesthesia residents and facilitate its incorporation into national anesthesia practice.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45288602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-26DOI: 10.1101/2020.05.23.20111054
Marco Pettinger, M. Momeni, Clemence Michaud, M. V. Van Dyck, David Kahn, Guillaume Lemaire
Background During the ongoing COVID-19 pandemic, healthcare workers are facing shortage in personal protective equipment, especially adequate respirators. Alternative do-it-yourself respirators (ADR) emerge, without any proof of protection. Objective Verify seal potential of two ADR compared to a common FFP2 respirator. Design Quality assessment pilot study. Setting Tertiary Care Hospital. Participants Ten anaesthesiology residents. Interventions Participants performed quantitative face-fit tests (QNFT) with three respirators to evaluate seal. A common FFP2 respirator was used as baseline (control group). ADR tested in this study are an Anaesthesia Face Mask (AFM) and a full-face Modified Snorkelling Mask (MSM) with a 3D-printed connector, both in conjunction with a breathing system filter. Main outcome measures Non-inferior seal performance of ADR over FFP2, assessed by calculated QNFT based on measured individual fit factors, as defined by the Occupational Safety and Health Administration. Results For each respirator a total of 90 individual fit factor measurements were taken. Within the control group, seal failed in 37 (41%) measurements but only in 10 (11%) within the AFM group and in 6 (7%) within the MSM group (P < 0.001 respectively). However, when calculating the final, mean QNFT results, no statistically significant difference was found between respirators. Successful QNFT were determined for 5 out of 10 participants in the control group, for 8 in the AFM group (P = 0.25) and for 7 in the MSM group (P = 0.69). Conclusion Both ADR do have the potential to provide non inferior seal compared to a common FFP2 respirator. While AFM respirators are easily assembled, snorkelling masks must undergo significant but feasible modifications. Our results suggest that those ADR masks might be further investigated as they seem to be viable alternatives for situations when certified respirators are not available.
{"title":"Verification of two Alternative Do-it-yourself Equipment Respirators Seal as COVID-19 Protection (VADERS-CoV): a quality assessment pilot study","authors":"Marco Pettinger, M. Momeni, Clemence Michaud, M. V. Van Dyck, David Kahn, Guillaume Lemaire","doi":"10.1101/2020.05.23.20111054","DOIUrl":"https://doi.org/10.1101/2020.05.23.20111054","url":null,"abstract":"Background During the ongoing COVID-19 pandemic, healthcare workers are facing shortage in personal protective equipment, especially adequate respirators. Alternative do-it-yourself respirators (ADR) emerge, without any proof of protection. Objective Verify seal potential of two ADR compared to a common FFP2 respirator. Design Quality assessment pilot study. Setting Tertiary Care Hospital. Participants Ten anaesthesiology residents. Interventions Participants performed quantitative face-fit tests (QNFT) with three respirators to evaluate seal. A common FFP2 respirator was used as baseline (control group). ADR tested in this study are an Anaesthesia Face Mask (AFM) and a full-face Modified Snorkelling Mask (MSM) with a 3D-printed connector, both in conjunction with a breathing system filter. Main outcome measures Non-inferior seal performance of ADR over FFP2, assessed by calculated QNFT based on measured individual fit factors, as defined by the Occupational Safety and Health Administration. Results For each respirator a total of 90 individual fit factor measurements were taken. Within the control group, seal failed in 37 (41%) measurements but only in 10 (11%) within the AFM group and in 6 (7%) within the MSM group (P < 0.001 respectively). However, when calculating the final, mean QNFT results, no statistically significant difference was found between respirators. Successful QNFT were determined for 5 out of 10 participants in the control group, for 8 in the AFM group (P = 0.25) and for 7 in the MSM group (P = 0.69). Conclusion Both ADR do have the potential to provide non inferior seal compared to a common FFP2 respirator. While AFM respirators are easily assembled, snorkelling masks must undergo significant but feasible modifications. Our results suggest that those ADR masks might be further investigated as they seem to be viable alternatives for situations when certified respirators are not available.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48252318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A.C. Bekono Zoa, C. Franssen, J. Brichant, C. Czarnetzki
Introduction : Various drugs and physiologic disturbances affect the action of neuromuscular blocking agents. If some are ignored by the anesthesiologist, e.g. in the absence of monitoring of neuromuscular function, the patient may be at risk of potentially severe consequences related to postoperative residual curarization. Case presentation : A 67-year-old female patient underwent septoplasty under general anesthesia with basic monitoring (three-lead electrocardiogram, non-invasive blood pressure, end-tidal partial pressure of carbon dioxide and SpO2) and a monitoring of neuromuscular function using acceleromyography of the adductor pollicis. General anesthesia was induced with propofol and sufentanil. After neuromuscular monitoring calibration, a single dose of rocuronium was given. Thereafter the trachea was intubated and anesthesia was maintained with sevoflurane. One hundred and two minutes after the administration of rocuronium, a 1% lidocaine solution containing 5µg/mL epinephrine was injected under the mucosa of the nasal septum immediately before the incision. Two minutes after this injection, the train of four ratio was significantly reduced. It took about 13 minutes to recover to the value recorded before the submucosal injection. Conclusion : Epinephrine increases the degree of muscle relaxation achieved by rocuronium, even when neuro-muscular function is recovering. Monitoring is the only mean to rule out a risk of postoperative residual curarization, given the numerous medications and factors interfering with the action of neuromuscular blocking agents.
{"title":"Enhancement of muscle relaxant effect of rocuronium by intraseptal injection of a solution containing lidocaïne and epinephrine : a case report","authors":"A.C. Bekono Zoa, C. Franssen, J. Brichant, C. Czarnetzki","doi":"10.56126/71.1.07","DOIUrl":"https://doi.org/10.56126/71.1.07","url":null,"abstract":"Introduction : Various drugs and physiologic disturbances affect the action of neuromuscular blocking agents. If some are ignored by the anesthesiologist, e.g. in the absence of monitoring of neuromuscular function, the patient may be at risk of potentially severe consequences related to postoperative residual curarization.\u0000\u0000Case presentation : A 67-year-old female patient underwent septoplasty under general anesthesia with basic monitoring (three-lead electrocardiogram, non-invasive blood pressure, end-tidal partial pressure of carbon dioxide and SpO2) and a monitoring of neuromuscular function using acceleromyography of the adductor pollicis. General anesthesia was induced with propofol and sufentanil. After neuromuscular monitoring calibration, a single dose of rocuronium was given. Thereafter the trachea was intubated and anesthesia was maintained with sevoflurane. One hundred and two minutes after the administration of rocuronium, a 1% lidocaine solution containing 5µg/mL epinephrine was injected under the mucosa of the nasal septum immediately before the incision. Two minutes after this injection, the train of four ratio was significantly reduced. It took about 13 minutes to recover to the value recorded before the submucosal injection.\u0000\u0000Conclusion : Epinephrine increases the degree of muscle relaxation achieved by rocuronium, even when neuro-muscular function is recovering. Monitoring is the only mean to rule out a risk of postoperative residual curarization, given the numerous medications and factors interfering with the action of neuromuscular blocking agents.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42955012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Measuring the systolic function of the left ventricle (LV) is essential in clinical practice. However, the complex organization of the myocardial fibers whose contraction results in the ejection of the stroke volume renders this assessment challenging. The ejection fraction of the left ventricle (LVEF) has long been the most popular measure of the systolic function of the left ventricle despite its numerous technical and non- technical limitations. More recently, the development of speckle-tracking echocardiography allowed the widespread adoption of myocardial deformation imaging indices such as the strain and the strain rate. Strain, and in particular, global longitudinal strain (GLS) has quickly gained popularity as an additional measure of the systolic function of the left ventricle. In comparison with the ejection fraction, GLS is easier to use, more reproducible, and more sensitive to mild changes in myocardial contractility. Strain is an interesting tool for diagnosis and prognostic stratification in both surgical and non-surgical patients. The purpose of this review is to describe the principles of strain use and to review its main applications, while focusing on the aspects relevant to the practice of anesthesia and intensive care medicine.
{"title":"Myocardial deformation imaging in anesthesia and perioperative medicine: a non systematic review","authors":"O. Jaquet, P. Amabili, J. Brichant, G. Hans","doi":"10.56126/71.1.03","DOIUrl":"https://doi.org/10.56126/71.1.03","url":null,"abstract":"Measuring the systolic function of the left ventricle (LV) is essential in clinical practice. However, the complex organization of the myocardial fibers whose contraction results in the ejection of the stroke volume renders this assessment challenging. The ejection fraction of the left ventricle (LVEF) has long been the most popular measure of the systolic function of the left ventricle despite its numerous technical and non- technical limitations. More recently, the development of speckle-tracking echocardiography allowed the widespread adoption of myocardial deformation imaging indices such as the strain and the strain rate. Strain, and in particular, global longitudinal strain (GLS) has quickly gained popularity as an additional measure of the systolic function of the left ventricle. In comparison with the ejection fraction, GLS is easier to use, more reproducible, and more sensitive to mild changes in myocardial contractility. Strain is an interesting tool for diagnosis and prognostic stratification in both surgical and non-surgical patients. The purpose of this review is to describe the principles of strain use and to review its main applications, while focusing on the aspects relevant to the practice of anesthesia and intensive care medicine.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48236190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Hamdi, J. Joris, M. Saveri, B. Javillier, R. Fontaine
We present the case of a 30-year-old man who developed chronic postsurgical pain (CPSP) after coloproctectomy with terminal ileostomy for severe inflammatory bowel disease refractory to medical treatments. CPSP was severe with negative impact on his quality of life and resistant to high doses of tramadol combined with antidepressants and benzodiazepine. Referred to our pain clinic he was first treated with repeated transversus abdominis plane (TAP) blocks which provided short-lasting pain relief. Because of the temporary effect of the infiltrations a catheter was then indwelled in the TAP under ultrasound guidance and local anesthetic was continuously infused for 10-days. Complete analgesia was reported during the infusion and persisted after removal of the catheter. Twelve months later, pain has markedly decreased, is reported as bearable and amenable with low doses of analgesics. A continuous TAP infusion was repeated twice separated by approximately one year. Thereafter no further infiltration was necessary.
{"title":"Continuous Posterior Transversus Abdominis Plane (TAP) block in the management of chronic postsurgical pain of the abdominal wall","authors":"K. Hamdi, J. Joris, M. Saveri, B. Javillier, R. Fontaine","doi":"10.56126/71.1.06","DOIUrl":"https://doi.org/10.56126/71.1.06","url":null,"abstract":"We present the case of a 30-year-old man who developed chronic postsurgical pain (CPSP) after coloproctectomy with terminal ileostomy for severe inflammatory bowel disease refractory to medical treatments. CPSP was severe with negative impact on his quality of life and resistant to high doses of tramadol combined with antidepressants and benzodiazepine. Referred to our pain clinic he was first treated with repeated transversus abdominis plane (TAP) blocks which provided short-lasting pain relief. Because of the temporary effect of the infiltrations a catheter was then indwelled in the TAP under ultrasound guidance and local anesthetic was continuously infused for 10-days. Complete analgesia was reported during the infusion and persisted after removal of the catheter. Twelve months later, pain has markedly decreased, is reported as bearable and amenable with low doses of analgesics. A continuous TAP infusion was repeated twice separated by approximately one year. Thereafter no further infiltration was necessary.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43317289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background : Postoperative nausea and vomiting (PONV) is one of the common complications after surgery. This randomized double-blind study was planned to compare the effectiveness of different antiemetic regimens for PONV prophylaxis in moderately high-risk patients. Methods : One hundred and sixty adult ASA grade I-II female patients undergoing day care gynecological laparoscopic procedures were randomly allocated into four groups. Group 1 patients (Control group) received 4 mg ondansetron, group 2 (P75 group) patients received 0.075 mg palonosetron, group 3 (P150 group) patients received 0.150 mg palonosetron, and group 4 (PD group) patients received 0.075 mg palonosetron and 8 mg dexamethasone after induction of anesthesia. Anesthesia was induced with propofol and fentanyl, and maintained with N2O-isoflurane in oxygen. The number of complete responders, frequency of nausea and vomiting episodes and the requirement of rescue antiemetic during 0-6 h, 6-24 h and 24-72 h after surgery were recorded. Results : Patients receiving dexamethasone and palonosetron combination had significantly less vomiting (p = 0.03) and required less rescue antiemetic as compared to Control group (p = 0.014). The incidence of nausea was low in all palonosetron groups as compared to the ondansetron group. The complete response rate was significantly high in the PD group as compared to other groups (p = 0.012). There was no significant difference in nausea and vomiting in patients receiving palonosetron 0.075 mg or 0.15 mg. Conclusions : We conclude that a dexamethasone-palonosetron combination is more effective than ondansetron and palonosetron alone for the prevention of PONV, while palonosetron 0.150 mg has no significant benefit over 0.075 mg for PONV prophylaxis in moderately high-risk patients.
{"title":"PONV prophylaxis after laparoscopic procedures - Comparison between Palonosetron 0.075mg, Palonosetron 0.15mg and a Palonosetron-Dexamethasone combination : a randomised controlled trial","authors":"N. Bharti, N. Panda, K. Kumari","doi":"10.56126/71.1.05","DOIUrl":"https://doi.org/10.56126/71.1.05","url":null,"abstract":"Background : Postoperative nausea and vomiting (PONV) is one of the common complications after surgery. This randomized double-blind study was planned to compare the effectiveness of different antiemetic regimens for PONV prophylaxis in moderately high-risk patients.\u0000\u0000Methods : One hundred and sixty adult ASA grade I-II female patients undergoing day care gynecological laparoscopic procedures were randomly allocated into four groups. Group 1 patients (Control group) received 4 mg ondansetron, group 2 (P75 group) patients received 0.075 mg palonosetron, group 3 (P150 group) patients received 0.150 mg palonosetron, and group 4 (PD group) patients received 0.075 mg palonosetron and 8 mg dexamethasone after induction of anesthesia. Anesthesia was induced with propofol and fentanyl, and maintained with N2O-isoflurane in oxygen. The number of complete responders, frequency of nausea and vomiting episodes and the requirement of rescue antiemetic during 0-6 h, 6-24 h and 24-72 h after surgery were recorded.\u0000\u0000Results : Patients receiving dexamethasone and palonosetron combination had significantly less vomiting (p = 0.03) and required less rescue antiemetic as compared to Control group (p = 0.014). The incidence of nausea was low in all palonosetron groups as compared to the ondansetron group. The complete response rate was significantly high in the PD group as compared to other groups (p = 0.012). There was no significant difference in nausea and vomiting in patients receiving palonosetron 0.075 mg or 0.15 mg.\u0000\u0000Conclusions : We conclude that a dexamethasone-palonosetron combination is more effective than ondansetron and palonosetron alone for the prevention of PONV, while palonosetron 0.150 mg has no significant benefit over 0.075 mg for PONV prophylaxis in moderately high-risk patients.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47869252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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