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Herve Bouaziz - One of the best experts on this subject based on the ideXlab platform.
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continuous peripheral nerve blocks in hospital wards after orthopedic surgery a multicenter prospective analysis of the quality of Postoperative Analgesia and complications in 1 416 patients
Anesthesiology, 2005Co-Authors: Xavier Capdevila, Herve Bouaziz, Philippe Pirat, Sophie Bringuier, Elisabeth Gaertner, Francois Singelyn, Nathalie Bernard, Olivier Choquet, Francis BonnetAbstract:Background:Continuous peripheral nerve block (CPNB) is the technique of choice for Postoperative Analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the Postoperative period are not well established. This issue was the aim of the study.Me
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Postoperative Analgesia after total knee replacement the effect of an obturator nerve block added to the femoral 3 in 1 nerve block
Anesthesia & Analgesia, 2004Co-Authors: D Macalou, Xavier Capdevila, S Trueck, Pascal Meuret, M Heck, F Vial, S Ouologuem, J M Virion, Herve BouazizAbstract:Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on Postoperative Analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative Analgesia was further provided by morphine IV via patient-controlled Analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% ± 9% in Group 1 and by 78% ± 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P ≤ 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early Postoperative period. The addition of an ONB to FNB improves Postoperative Analgesia after TKR.
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tramadol added to 1 5 mepivacaine for axillary brachial plexus block improves Postoperative Analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Philippe Cuvillon, Cornelia Blunt, Eric Viel, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and Postoperative Analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of Postoperative Analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting Analgesia in the Postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional Postoperative Analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of Analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of Postoperative Analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary brachial plexus block improves Postoperative Analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Philippe Cuvillon, Cornelia Blunt, Eric Viel, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and Postoperative Analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of Postoperative Analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting Analgesia in the Postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional Postoperative Analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of Analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of Postoperative Analgesia in a dose dependent fashion with acceptable side effects.
Philippe Cuvillon - One of the best experts on this subject based on the ideXlab platform.
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tramadol added to 1 5 mepivacaine for axillary brachial plexus block improves Postoperative Analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Philippe Cuvillon, Cornelia Blunt, Eric Viel, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and Postoperative Analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of Postoperative Analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting Analgesia in the Postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional Postoperative Analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of Analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of Postoperative Analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary brachial plexus block improves Postoperative Analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Philippe Cuvillon, Cornelia Blunt, Eric Viel, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and Postoperative Analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of Postoperative Analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting Analgesia in the Postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional Postoperative Analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of Analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of Postoperative Analgesia in a dose dependent fashion with acceptable side effects.
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the continuous femoral nerve block catheter for Postoperative Analgesia bacterial colonization infectious rate and adverse effects
Anesthesia & Analgesia, 2001Co-Authors: Philippe Cuvillon, J Ripart, L Lalourcey, Eric Veyrat, Joel Lhermite, Christophe Boisson, Ezzedine Thouabtia, Jean Jacques EledjamAbstract:We investigated the incidence of bacterial and vascular or neurological complications resulting from femoral nerve catheters used for Postoperative Analgesia. Patients requiring continuous femoral blockade were consecutively included. Using surgical aseptic procedure, 211 femoral nerve catheters were placed (short-beveled insulated needle, peripheral nerve stimulator). After 48 h, each catheter was removed and semiquantitative bacteriological cultures were performed on each distal catheter tip. Postoperative Analgesia and antibiotics were standardized. All complications during the insertion of the catheters and Postoperatively (after 48 h and 6 wk) were noted. Few initial complications with no immediate or delayed complications were noted (20 difficult insertions, 3 impossible injections, 3 ineffective catheters, and 12 vascular punctures). After 48 h, 208 catheters were analyzed; 57% had positive bacterial colonization (with a single organism in 53%). The most frequent organisms were Staphylococcus epidermidis (71%), Enteroccus (10%), and Klebsiella (4%). Neither cellulitis nor abscess occurred. Three transitory bacteriemias likely related to the catheter occurred. After 6 wk, no septic complications were noted. One femoral paresthesia, partially recovered 1 yr later, was noted. We conclude that the risk of bacterial complications is small with femoral nerve catheters, although the rate of colonization is frequent.
Sebastien Robaux - One of the best experts on this subject based on the ideXlab platform.
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tramadol added to 1 5 mepivacaine for axillary brachial plexus block improves Postoperative Analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Philippe Cuvillon, Cornelia Blunt, Eric Viel, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and Postoperative Analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of Postoperative Analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting Analgesia in the Postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional Postoperative Analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of Analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of Postoperative Analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary brachial plexus block improves Postoperative Analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Philippe Cuvillon, Cornelia Blunt, Eric Viel, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and Postoperative Analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of Postoperative Analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting Analgesia in the Postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional Postoperative Analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of Analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of Postoperative Analgesia in a dose dependent fashion with acceptable side effects.
Daniel I Sessler - One of the best experts on this subject based on the ideXlab platform.
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anesthesia and Postoperative Analgesia after percutaneous hallux valgus repair in ambulatory patients
Annales Francaises D Anesthesie Et De Reanimation, 2012Co-Authors: Frederic Adam, Daniel I Sessler, E Pellelancien, T Bauer, N Solignac, M ChauvinAbstract:Abstract Background Postoperative pain is often severe after hallux valgus repair. Sciatic nerve blocks with long-acting local anesthetics have been recommended for surgical anesthesia and Postoperative Analgesia. However, a novel percutaneous approach may require less Analgesia and make the procedure suitable for ambulatory care. We thus tested the hypothesis that mid-foot block and sciatic nerve blocks provide comparable surgical anesthesia and Postoperative Analgesia, but that patients ambulate independently sooner after mid-foot block. Study design Prospective, randomized study. Methods Forty patients scheduled for ambulatory percutaneous hallux valgus repair were randomly assigned to two anesthesia and Analgesia blocks: foot infiltration achieved by a mild foot block, or sciatic nerve block (30 mL of 7.5% ropivacaine for each block). Surgery was performed without sedation or additional Analgesia. Both groups were given oral paracetamol/codeine and ketoprofene systematically; tramadol was added if necessary. Walking ability and pain scores were assessed for 48 Postoperative hours. Results Demographic and morphometric characteristics, and duration of surgery were similar in each group. Pain scores were comparable and low in each group at rest and while walking. The time to ambulation without assistance was significantly less for patients in the infiltration group (3.8 ± 1.4 hours) than patients in the sciatic group (19.2 ± 9.5 hours; P Conclusion After percutaneous hallux valgus repair, mid-foot block and sciatic nerve block provided comparable Postoperative Analgesia. However, mid-foot block seems preferable since the time to ambulation without assistance is much reduced.
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a single preoperative dose of gabapentin 800 milligrams does not augment Postoperative Analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery
Anesthesia & Analgesia, 2006Co-Authors: Frederic Adam, Daniel I Sessler, Christophe Menigaux, Marcel ChauvinAbstract:BACKGROUND: Inadequate Analgesia is common after shoulder arthroscopy. Both interscalene blocks and gabapentin are effective methods of pain management under various circumstances. We tested the hypothesis that gabapentin augments Postoperative Analgesia provided by interscalene brachial plexus block in patients having ambulatory arthroscopic shoulder surgery. METHODS: Sixty patients were randomly assigned to receive oral gabapentin, 800 mg, or placebo 2 h before surgery. An interscalene brachial plexus block with 0.3 mL/kg of 0.5% ropivacaine was performed. General anesthesia was maintained with sevoflurane and included a single 1-g/kg dose of remifentanil. Postoperative Analgesia was initially provided with morphine and subsequently with ketoprofene (150 mg orally twice daily) and a combination of 400 mg acetaminophen and 30 mg dextropropoxyphene as needed. Pain scores, analgesic requirements, and side effects were assessed in the ambulatory unit and at home for 48 h. RESULTS: Emergence from general anesthesia was similar in both groups. There were no significant differences in pain scores, first Postoperative request for Analgesia, or oral analgesic consumption. The incidence of side effects was comparable in both groups, except that headaches were less frequent in the gabapentin group. CONCLUSION: A single preoperative dose of gabapentin (800 mg) does not augment Postoperative Analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery. (Anesth Analg 2006;103:1278‐82)
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nefopam and ketamine comparably enhance Postoperative Analgesia
Anesthesia & Analgesia, 2005Co-Authors: Barbara Kapfer, P Alfonsi, Daniel I Sessler, B Guignard, M ChauvinAbstract:Opioids alone sometimes provide insufficient Postoperative Analgesia. Co-administration of drugs may reduce opioid use and to improve opioid efficacy. We therefore tested the hypothesis that administration of ketamine or nefopam, to Postoperative patients with pain only partly alleviated by morphine, limits the amount of subsequent opioid necessary to produce adequate Analgesia. Patients (n=77) recovering from major surgery were given up to 9 mg intravenous morphine. Those still suffering from pain were randomly assigned to blinded administration of: 1) isotonic saline (Control, n=21); 2) ketamine 10 mg (Ketamine, n=22); or, 3) nefopam 20 mg (Nefopam, n=22). Three-mg morphine boluses were subsequently given at 5-minute intervals until adequate Analgesia was obtained, or 60 minutes elapsed after the beginning of the study drug administration, or ventilation became insufficient (respiratory rate < 10 breath/minute or saturation by pulse oxymetery < 95%). Supplemental morphine (i.e., after test drug administration) requirements were significantly greater in the Control group [17 ± 10 (SD) mg] than in the Nefopam (10 ± 5 mg, P < 0.005) or Ketamine (9 ± 5 mg, P < 0.001) groups. Morphine titration was successful in all Ketamine and Nefopam patients, but failed in four Control patients (two from respiratory toxicity and two from persistent pain). Tachycardia and profuse sweating were more frequent in patients given nefopam and sedation was greater with ketamine; however, the incidence of other potential complications did not differ between groups. Implications We conclude that ketamine 10 mg and nefopam 20 mg comparably potentiate opioid Analgesia, each reducing opioid need by approximately 40%. Ketamine administration was associated with sedation whereas nefopam produced tachycardia and sweating. However, none of the side effects was serious. Either drug can thus be used to potentiate opioid Analgesia.
Ahmed M Moeen - One of the best experts on this subject based on the ideXlab platform.
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topical versus caudal ketamine bupivacaine combination for Postoperative Analgesia in children undergoing inguinal herniotomy
Saudi Journal of Anaesthesia, 2017Co-Authors: Hala Saad Abdelghaffar, Seham M Moeen, Ahmed M MoeenAbstract:Background: Multiple studies claim that caudal administration of ketamine causes effective Postoperative Analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal Analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical Analgesia (topical group). The duration of Postoperative Analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h Postoperative. Results: Kaplan–Meier survival analysis of Analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of Postoperative Analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P P th till 48 th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for Postoperative Analgesia in children undergoing inguinal hernia repair.
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Topical versus caudal ketamine/bupivacaine combination for Postoperative Analgesia in children undergoing inguinal herniotomy
Wolters Kluwer Medknow Publications, 2017Co-Authors: Hala Saad Abdel-ghaffar, Ahmed M Moeen, Seham M MoeenAbstract:Background: Multiple studies claim that caudal administration of ketamine causes effective Postoperative Analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal Analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical Analgesia (topical group). The duration of Postoperative Analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h Postoperative. Results: Kaplan–Meier survival analysis of Analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of Postoperative Analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P < 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for Postoperative Analgesia in children undergoing inguinal hernia repair
