Compared with FNB, ACB results in significant quadriceps motor sparing and significantly preserved balance.

The analgesic benefits of CISB found in the PACU and immediately after discharge extend through the intermediate recovery period ending on postoperative day 7.

SummaryPlatelet dysfunction after cardiopulmonary bypass contributes to microvascular bleeding and is associated with blood transfusion and resternotomy. Platelet count can be readily performed, but currently there are no standardised, reproducible, rapidly available platelet function tests. We studied platelet function as measured by multiple electrode platelet aggregometery (multiplate) and light transmission aggregometry in 44 patients undergoing routine coronary artery surgery. Platelet aggregation as measured by multiplate was reduced during and after cardiopulmonary bypass compared with baseline with evidence of partial recovery by the time of transfer to ITU. In patients transfused blood, platelet aggregation measured by multiplate was reduced during chest closure with adenosine diphosphate (18 U vs 29 U, p = 0.01) and thrombin receptor agonist peptide-6 agonist (65 U vs 88 U, p = 0.01) compared with patients not transfused. This suggests that multiplate, a new point of care analyser, can detect platelet dysfunction in this setting. Platelet dysfunction after cardiopulmonary bypass (CPB) is a major contributor to microvascular bleeding, and associated with excessive blood loss, perioperative blood transfusion and surgical re-exploration. The effects of CPB include dilution (and reduced concentration of platelets) and alteration in platelet structure and function [1,2]. In addition, use of platelet inhibitors in the peri-operative period is associated with platelet inactivation.Administration of blood products during excessive bleeding is commonly required, but is associated with significant morbidity and mortality, including lung injury, immunomodulation, fluid overload and infection [3]. Transfusion algorithms in common use include established laboratory and near patient testing to guide clinicians in use of blood products. Reduced platelet count is a universal trigger for platelet concentrate administration. Thromboelastography is also commonly performed, and maximum amplitude is used by some as a surrogate for clot strength and consequently, platelet activity and fibrinogen level [4]. Platelet function per se is, however, not routinely assessed, mainly because of difficulty with testing and a lack of agreement between different modalities [5,6].

Intraarticular bupivacaine and levobupivacaine provided better postoperative analgesia both at rest and during mobilization in total knee replacement surgery compared to control. Tramadol consumption and hospital stay were also decreased in the study groups.

Background: Ultrasound guidance during peripheral nerve blocks has allowed for reduction in dose and volume of local anesthetic required to accomplish successful blockade using multiple injections through a needle. The authors undertook this study to determine the minimal effective volume required to accomplish successful interscalene brachial plexus block (ISB) through the catheter. Methods: After obtaining institutional ethics committee approval and written informed consent, patients aged 18-75 yr and scheduled for arthroscopic shoulder surgery under ISB were enrolled. All patients using a step-up/step-down method and the starting dose of 15 ml of 0.75% ropivacaine received an ultrasound-guided ISB catheter. The injection volume was increased or decreased by 1 ml in case of block failure or block success, respectively. Results: The authors found that the proportion of patients with successful blockade increased sharply from approximately 57% at 6 ml to 100% by 7 ml, indicating that a small increase in volume of ropivacaine 0.75% markedly affects the success rate. A total of 12 ISB with injection volume less than 7 ml resulted in successful anesthesia within 30 min, yielding an ED95 of 7 ml (95% CI 6.8-7.2) ropivacaine 0.75%. For the group as a whole, the median (min-max) sensory block onset time was 5 (5-20) min, the median (min-max) motor blocks for the biceps and the deltoid muscles were 7.5 (5-15) min and 10 (5-15) min, respectively. The median (min-max) block duration was 8.9 (3-15) h. Conclusions: An injection of a minimum of 7 ml of ropivacaine 0.75% through the catheter is required for success rate and timely onset of surgical anesthesia with ISB.

Therapeutic, III.

No abstract

BackgroundBipolar and monopolar transurethral resection of prostate (TURP) are both widely used for surgical treatment of benign prostatic hyperplasia. Systemic absorption of irrigation fluids during TURP operations leads to variations in blood chemistry. The aim of this prospective clinical study was to compare two different surgical techniques and the systemic effects of irrigation solutions (5 % mannitol vs. 0.9 % sodium chloride) under standardized anesthesia care.MethodsFifty-two patients who were scheduled for elective TURP were enrolled in the study. Patients were divided into two groups; the group M; 5 % mannitol was used for irrigation and the group B; 0.9 % sodium chloride was used for irrigation. Spinal anesthesia was performed to all patients. The patients’ demographics, prostate volumes, hemodynamic parameters, volumes of irrigation, and IV fluids were recorded. Serum electrolytes (Na+, K+) and hemoglobin (Hb) were analyzed in blood samples taken before the operation (control), at the 45th min of the operation (1st measurement), and 1 h after the end of the surgery (2nd measurement) and recorded.ResultsThe Na+ value of group M was significantly lower in both the 1st and 2nd measurements compared with the control value (p < 0.001 and p < 0.001). Na+ values of group M were also significantly lower than group B in both the 1st and 2nd measurements (p < 0.001 and p < 0.001). The change in Na+ levels was found to be statistically significant (p < 0.001) in group M, whereas the intergroup changes were not statistically significant in group B.ConclusionOur results demonstrated that bipolar resection coupled with 0.9 % sodium chloride has minimal effects on serum sodium levels compared with monopolar resection. Clinicaltrials.gov identifier NCT02681471