Abstract Study Objective To compare the efficacy of ultrasound-guided tansversus abdominis plane (TAP) block with placebo for postoperative analgesia after retropubic radical prostatectomy (RRP). ...Design Prospective, randomized, double-blinded study. Setting Tertiary-care Veterans Affairs (VA) hospital. Patients ASA physical status 1, 2, and 3 patients scheduled for RRP. Interventions Patients were randomized to two groups: the TAP group and the control group. All patients underwent an ultrasound-guided TAP block procedure after induction of general anesthesia and received either local anesthetic (TAP group) or normal saline (control group). Measurements Opioid use and verbal analog pain scores at 1, 6, 12, and 24 hours after surgery were recorded, as was the frequency of side effects. Times to ambulation and first oral intake also were recorded. Main Results The TAP block group had lower pain scores and required less total opioid in the first 24 hours after surgery. Time to first oral intake and time to ambulation were similar between the two groups. Conclusion The TAP block has early benefits in postoperative analgesia after RRP.
Abstract Health care reform is directing clinical practice towards improving outcomes and minimizing complications. Preoperative identification of high-risk patients and modifiable risk factors ...present opportunity for clinical research. A total of 49,475 total hip arthroplasty patients were identified from National Surgical Quality Improvement Program between 2006 and 2013. We compared morbidly obese patients (BMI ≥ 40 kg/m2 ) and non-morbidly obese patients (BMI 18.5–40 kg/m2 ). We also compared patients with hypoalbuminemia (serum albumin < 3.5 g/dL) against those with normal albumin. Our study demonstrates that hypoalbuminemia is a significant risk factor for mortality and major morbidity among total hip arthroplasty patients, while morbid obesity was only associated with an increased risk of superficial surgical site infection. Impressively, hypoalbuminemia patients carried a 5.94-fold risk of 30-day mortality.
Abstract Study objective The study objective is to examine the analgesic effect of 3 doses of dexamethasone in combination with low concentration local anesthetics to determine the lowest effective ...dose of dexamethasone for use as an adjuvant in supraclavicular brachial plexus nerve block. Design The design is a prospective randomized double-blinded clinical study. Setting The setting is an academic medical center. Patients The patients are 89 adult patients scheduled for shoulder arthroscopy. Interventions All patients were randomly assigned into 1 of 4 treatment groups: (i) bupivacaine, 0.25% 30 mL; (ii) bupivacaine, 0.25% 30 mL with 1-mg preservative-free dexamethasone; (iii) bupivacaine, 0.25% 30 mL with 2-mg preservative-free dexamethasone; and (iv) bupivacaine, 0.25% 30 mL with 4-mg preservative-free dexamethasone. All patients received ultrasound-guided supraclavicular brachial plexus nerve blocks and general anesthesia. Measurements The measurements are the duration of analgesia and motor block. Main results The median analgesia duration of supraclavicular brachial plexus nerve block with 0.25% bupivacaine was 12.1 hours; and 1-, 2-, or 4-mg dexamethasone significantly prolonged the analgesia duration to 22.3, 23.3, and 21.2 hours, respectively ( P = .0105). Dexamethasone also significantly extended the duration of motor nerve block in a similar trend ( P = .0247). Conclusion Low-dose dexamethasone (1-2 mg) prolongs analgesia duration and motor blockade to the similar extent as 4-mg dexamethasone when added to 0.25% bupivacaine for supraclavicular brachial plexus nerve block.
Hip fracture is one of the most common orthopedic conditions associated with significant morbidity and mortality. Patients with hip fracture are usually older, with significant comorbidities. Delayed ...surgical treatment beyond 48 hours after admission is associated with significantly higher mortality. Hereby clinicians are presented with the challenge to optimize the complex hip fracture within a short time period. This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient's condition and improve perioperative outcomes.
Abstract The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTKA) has emerged as a practice to minimize perioperative risks, although with few data ...providing an evidence base. A total of 41,664 BTKA patients from Nationwide Inpatient Sample data between 1998 and 2010 were identified, and categorized into three groups, same day, staging 1–3 days, and staging 4–7 days BTKA. Staging BTKA 1–3 days apart was associated with increased rates for complications compared to same day BTKA, while staging 4–7 days BTKA was associated with similar complication profiles compared to same day BTKA. Our study suggests that same day BTKA for selective patient population is preferable, and staging BTKA either 1–3 days or 4–7 days apart should be discouraged.
Abstract The perioperative management of a patient receiving a bilateral hand transplant is presented. The anesthetic management required careful fluid administration, homeothermic temperature ...maintenance, and postoperative analgesia. The role of different anesthesia subspecialties is highlighted.
PDF
