SummaryWe compared the duration of analgesia produced by a mixture of lignocaine and bupivacaine, either alone or combined with morphine (75 mg.kg ¹1 ), buprenorphine (3 mg.kg ¹1 ) or sufentanil (0.2 mg.kg ¹1 ) in 80 patients after brachial plexus block for orthopaedic surgery of the upper limb. The characteristics of analgesia were evaluated hourly using a visual analogue scale. The analgesia was considered satisfactory for scores of 30 or less. The median duration (range) of satisfactory analgesia was: 11.5 (8-15) h without an opioid, 21 (9-27) h with morphine, 20 (14-34) h with buprenorphine and 24.5 (11-38) h with sufentanil. We conclude that the addition of an opioid to a local anaesthetic mixture lengthens the duration of analgesia. The demonstration that opioid receptors are present in the peripheral nervous system [1] prompted recent investigations of the effects of using opioids, alone or combined with local anaesthetics, for regional analgesia procedures like brachial plexus block. Several authors have investigated the efficacy of injecting opioids into the brachial plexus sheath [2][3][4][5][6][7][8][9][10][11][12][13][14], but the results remain inconclusive. Some authors did not observe any benefit from adding opioids [6,7,[9][10][11], but the drugs and doses of opioids and local anaesthetics and the populations of patients, were different in the various studies. Lipid solubility and the affinity of the different opioids for their receptors seemed to be important factors [1]. The aim of this study was to evaluate the effects of different opioids which have either different receptor affinities or different lipid solubilities in patients scheduled for osteosynthesis of a fractured upper limb, without any signs of inflammation. For this purpose, we compared the quality and the duration of the analgesia produced by a brachial plexus block with a mixture of lignocaine and bupivacaine, either alone or combined with morphine, buprenorphine or sufentanil.
MethodsThe study was approved by our local ethics committee and informed consent was obtained from the 89 participating ASA grade 1 or 2 patients who were less than 65 years old. They were scheduled to undergo osteosynthesis of the upper limb under brachial plexus anaesthesia. After oral medication with hydroxyzine 100 mg given 2 h before surgery, the brachial plexus block was performed with the aid of a nerve stimulator, using the supraclavicular technique. The patients were randomly allocated into four groups: the control group (group C), which was given a mixture of 1 mg.kg ¹1 of bupivacaine 0.5% and 2 mg.kg
¹1of lignocaine 1% with 1 : 200 000 adrenaline and groups M, B and S, which were all given the same mixture, combined with either morphine 75 mg.kg ¹1 , buprenorphine 3 mg.kg ¹1 or sufentanil 0.2 mg.kg ¹1 . The opioids were diluted in the bupivacaine, in order to obtain the same volume per kilogram in all the groups. In all cases, there was an interval of more than 45 min between the injection of the anaesthetic solution and the surgical procedure.
A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.
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