The relationship of intraabdominal pressure changes to blood loss were examined with a rectal balloon pressure catheter during spinal surgery. Blood loss tended to increase with an increase in intraabdominal pressure in the narrow pad support width of the Wilson frame.

No abstract

Background: Continuous femoral 3-in-1 block alone is insufficient for the treatment of severe pain after total knee replacement (TKR). Intrathecal (IT) morphine provides effective postoperative analgesia but may result in many side effects. The optimal dose of spinal morphine when combined with continuous 3-in-1 block after TKR is not known.Methods: Patients were randomized to receive IT morphine in five groups (n = 20 per group): 1) 0.0 mg, 2) 0.05 mg, 3) 0.1 mg, 4) 0.15 mg, and 5) 0.2 mg. All patients received continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 minutes. The intensity of pain at rest and on movement of the knee was assessed by using a visual analog scale for the first two postoperative days.Results: All treatment groups produced effective pain relief and decreased cumulative femoral PCA bolus use of 0.125% bupivacaine compared with control, respectively (P ＜ 0.05); however, there were no significant differences among the treatment groups. The incidence of vomiting was significantly more frequent with 0.1−0.2 mg IT morphine groups compared with control, respectively (P ＜ 0.05). The rate of administration of antipruritic medication was increased as IT morphine dose increased (P ＜ 0.05).Conclusions: Use of 0.05 mg IT morphine would appear to provide the optimal balance between pain relief and adverse effects following TKR.

BackgroundThe optimal dose infusion of 0.125% bupivacaine via a femoral catheter after total knee replacement (TKR) has not been defined. This study examined various dose infusions of bupivacaine to determine the analgesic quality in patients receiving a continuous femoral nerve block (CFNB).MethodsPatients were randomized to receive a single-injection femoral nerve block (SFNB) or CFNB performed with 20 ml of 0.125% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine in four groups (n = 20 per group): 1) 0 ml/h (SFNB), 2) 2 ml/h, 3) 4 ml/h, and 4) 6 ml/h. The pain intensity at rest and on knee movement was assessed using a visual analog scale (VAS) for the first 2 postoperative days. The cumulative bolus use of IV patientcontrolled analgesia (PCA) with a morphine-ketorolac combination was evaluated.ResultsA lower cumulative bolus of IV PCA was noted in all CFNB groups compared to SFNB on postoperative days (PODs) 1 and 2, respectively (P < 0.05). Lower VAS scores at rest were observed in the 4 ml/h and 6 ml/h groups than in the SFNB group on PODs 1 and 2, respectively, but only on POD 2 in the 2 ml/h group (P < 0.05). Lower VAS scores on movement were noted in the 4 ml/h than the SFNB group on PODs 1 and 2, but only on POD 1 in 6 ml/h (P < 0.05).ConclusionsThe minimum effective infusion rate of 0.125% bupivacaine for CFNB after TKR appears to be 4 ml/h according to the VAS pain scores.

Patient-controlled analgesia (PCA) is an important means for postoperative analgesia with parenteral opioid. However, postoperative nausea and vomiting (PONV) remains a major problem with a PCA system. Droperidol is used in PCA to prevent PONV. Extrapyramidal reactions by droperidol are, however, occasionally induced. We describe two cases of severe extrapyramidal hypertonic syndrome with an intravenous administration of droperidol in PCA in young patients, following orthopedic surgery.

Background: Most of the patients who received a 3-in-1 nerve block for analgesia after total knee replacement (TKR) complained of pain in the back of the knee. We investigated the value of an intrathecal (IT) morphine in patients receiving continuous 3-in-1 nerve block with a PCA technique for pain control after unilateral TKR.Methods: Group 1 (n = 20) received spinal anesthesia with IT fentanyl 10μg. Group 2 (n = 20) received spinal anesthesia with IT morphine 0.1 mg. All patients received continuous 3-in-1 nerve block performed with 20 ml of 0.25% bupivacaine with epinephrine 1：200000, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 min. The intensity of pain at rest and on movement was assessed by the patients using a visual analog scale (VAS) for the first 2 postoperative days.Results: Patients in Group 2 reported significantly lower VAS pain scores at rest than those in Group 1 for the first 1 day (P ＜ 0.05). Cumulative PCA bolus use of 0.125% bupivacaine in Group 2 was significantly lower than those in Group 1 for the first 2 days (P ＜ 0.05). The incidences of pruritus in Groups 1 and 2 were 0 and 50%, respectively (P ＜ 0.01).Conclusions: We determined that the addition of IT morphine 0.1 mg to continuous femoral 3-in-1 nerve block improves postoperative analgesia after TKR.

No abstract

No abstract