Purpose
Post-craniotomy pain is a common clinical issue and its optimal management remains incompletely studied. Utilization of a regional scalp block has the potential advantage of reducing ...perioperative pain and opioid consumption, thereby facilitating optimal postoperative neurologic assessment. The purpose of this study was to assess the efficacy of regional scalp block on post-craniotomy pain and opioid consumption.
Methods
We performed a prospective randomized-controlled trial in adults scheduled to undergo elective supratentorial craniotomy under general anesthesia to assess the efficacy of postoperative bilateral scalp block with 0.5% bupivacaine with 1:200,000 epinephrine compared with placebo on postoperative pain and opioid consumption. The primary outcome was the visual analogue scale (VAS) for pain at 24 hr postoperatively.
Results
Eighty-nine patients were enrolled (
n
= 44 in block group;
n
= 45 in control group). There was no difference in the mean (standard deviation) VAS score at 24 hr postoperatively between the treatment group and the control group 31.2 (21.4) mm
vs
23.0 (19.2) mm, respectively; mean difference, 6.6; 95% confidence interval, -2.3, 15.5;
P
= 0.15. There was also no significant difference in postoperative opioid consumption. Distribution of individual VAS score and opioid consumption revealed that postoperative pain was highly variable following craniotomy. Time to hospital discharge was not different between treatment and placebo groups. No adverse events associated with scalp block were identified.
Conclusion
These data show that bilateral scalp blocks using bupivacaine with epinephrine did not reduce mean postoperative VAS score or overall opioid consumption at 24 hr nor the time-to-discharge from the postanesthesia care unit or from hospital.
Trial registration
www.ClinicalTrials.gov
, NCT00972790; registered 9 September, 2009.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A growing number of adult patients with congenital heart disease (ACHD) are entering the healthcare system as a result of advances in the diagnosis and management of congenital heart defects. Heart ...failure is a common final pathway for this diverse patient population, representing the leading cause of mortality in ACHD patients. Herein, we review present guideline-directed management of heart failure in ACHD patients.
There exists a dearth of data to guide management of ACHD-related heart failure. Given this gap, recent guidelines have been limited in the recommendations they can provide for this patient population, with practitioners being consequently forced to generalize findings from studies of acquired heart disease patients based on mechanistic plausibility. The small number of studies directly assessing ACHD patients have been largely limited in their clinical relevance through being negative, small, observational, limited to specific subsets of ACHD patients or assessing nonvalidated outcomes.
Despite the prevalence and impact of ACHD-related heart failure, there are limited evidence-based therapies for its management. Given the rising burden of this clinical problem, definitive trials assessing newer therapies are required to establish their potential role in heart failure amongst ACHD patients.
Anemia is associated with adverse outcomes in perioperative patients. Understanding the adaptive cellular and physiologic responses may help define the associated mechanisms and support utilization ...of effective patient blood management treatment strategies to improve patient outcomes.
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In a randomized trial, 5243 patients undergoing cardiac surgery were assigned to a restrictive or a liberal red-cell transfusion threshold. The restrictive threshold was noninferior to the liberal ...one for the composite outcome of death, myocardial infarction, stroke, or renal failure.
OBJECTIVE:Restrictive red cell transfusion is recommended to minimize risk associated with exposure to allogeneic blood. However, perioperative anemia is an independent risk factor for adverse ...outcomes after cardiovascular surgery. The purpose of this systematic review and meta-analysis is to determine whether perioperative restrictive transfusion thresholds are associated with inferior clinical outcomes in randomized trials of cardiovascular surgery patients.
DATA SOURCES:The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception to October 2013; reference lists of published guidelines, reviews, and associated articles, as well as conference proceedings. No language restrictions were applied.
STUDY SELECTION:We included controlled trials in which adult patients undergoing cardiac or vascular surgery were randomized to different transfusion thresholds, described as a hemoglobin or hematocrit level below which RBCs were transfused.
DATA EXTRACTION:Two authors independently extracted data from included trials. We pooled risk ratios of dichotomous outcomes and mean differences of continuous outcomes across trials using random-effects models.
DATA SYNTHESIS:Seven studies (enrolling 1,262 participants) met inclusion criteria with restrictive and liberal transfusion thresholds most commonly differing by a hemoglobin of 1 g/dL or hematocrit of 6–7%, resulting in decreased transfusions by 0.71 units of RBCs (95% CI, 0.31–1.09, p = 0.0002) without an associated change in adverse eventsmortality (risk ratio, 1.12; 95% CI, 0.65–1.95; p = 0.60), myocardial infarction (risk ratio, 0.94; 95% CI, 0.30–2.99; p = 0.92), stroke (risk ratio, 1.15; 95% CI, 0.57–2.32; p = 0.70), acute renal failure (risk ratio, 0.98; 95% CI, 0.64–1.49; p = 0.91), infections (risk ratio, 1.23; 95% CI, 0.85–1.78; p = 0.27), or length of stay. There was no between-trial heterogeneity for any pooled analysis. Including four pediatric trials (456 participants) and 10 trials utilizing only intraoperative acute normovolemic hemodilution (872 participants) did not substantially change the results except that unlike the transfusion threshold trials, the hemodilution trials did not reduce the proportion of patients transfused (interaction p = 0.01).
CONCLUSIONS:Further randomized controlled trials are necessary to determine the optimal transfusion strategy for patients undergoing cardiovascular surgery.
Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery Jimenez-Rivera, Juan J; Iribarren-Sarrías, Jose L; Martínez-Sanz, Rafael ...
New England journal of medicine/The New England journal of medicine,
05/2017, Volume:
376, Issue:
19
Journal Article
Peer reviewed
Open access
To the Editor:
Myles et al. (Jan. 12 issue)
1
found that the risk of death was not significantly higher with tranexamic acid than with placebo among patients undergoing cardiac surgery. This drug has ...a class IA indication for bleeding prophylaxis, decreasing the use of blood products and the risk of reintervention. Doses that are less than 50 mg per kilogram of body weight are effective in preventing bleeding as well as in decreasing the inflammatory response that is associated with cardiopulmonary bypass.
2
Patients with the 5G/G genotype had a greater blood-sparing benefit with the use of tranexamic acid than those . . .
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