This study assessed the efficacy of a patient-controlled regional analgesia technique for either psoas compartment block or femoral nerve block after total knee replacement in 68 patients who were randomly divided into these two groups. All patients received 40 ml of 0.25% bupivacaine via femoral or psoas catheters before general anesthesia, and then, as patient-controlled regional analgesia, 10-ml boluses of 0.125% bupivacaine, with a lockout time of 60 min over 48 h. Pain scores, sensory block, supplemental analgesia, bupivacaine consumption, and side effects were recorded. All measured parameters were comparable in the two groups. Both techniques achieved a good quality of analgesia and satisfaction without any major side effect.
Introduction: Colorectal surgery which is often performed for colorectal cancer, has some complications such as severe visceral pain or delaying of intestinal activity. It has been shown that, thoracic epidural analgesia (TEA) combined with general anesthesia was effective after abdominal operations (1,2,3).Materials and Methods: After the approval of ethical committee, 17 patients undergoing colorectal surgery were randomized into two groups after standart premedication and anesthesia induction: Group I (nϭ8) an epidural catheter was placed at thoracic 9-10 interspace and bupivacaine %0.5 ϩ morphine 5 mg was administered via the catheter before the surgical incision and at the closure of the peritoneum; Group II (nϭ9) patients were administered morphine intravenously at the same times. Anesthesia was maintained with sevofluraneϩN2O/O2 in all patients. Morphine was administered via sevofluraneϩthoracic epidural PCA (TPCEA)in Group I; and i.v PCA in Group II, postoperatively. Haemodynamic response to incision, intraoperative haemodynamics, intra-postoperative opioid consumptions, time to extubation, postoperative pain scores; nausea-vomiting, time to intestinal activity, oral nutrition and first mobilization were recorded.Results: In Group I, haemodynamic response to incision was not seen while heart rate and mean arterial pressure elevated in Group II (pϽ0.05). Intra and postoperative haemodynamics were stable in Group I. Time to extubation, oral nutrition and mobilization were shorter; VAS scores and morphine consumption were lower and number of patients suffered vomiting was lesser in group I (pϽ0.05, pϽ0.01).Conclusion: According to preliminary results, we conclude that TEA plus general anesthesia followed by TPCEA has advantages over general anesthesia followed by i.v PCA in patients undergoing colorectal surgery.
References: 1-Rimaitis K. et al Comparison of two different methods of analgesia.Postoperative course after colorectal cancer surgery. Medicina 2003, 39(2): 296-303. 2-Mann C.et al. Comparison of intravenous or epidural patient controlled analgesia in the elderly after major abdominal surgery.Anesthesiology 2000, 92(2): 433-441. 3-Carli F et al. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery. Disease colon rectum 2001, 44(8):1083-1089.122. The efficacy of psoas compartment block and extended femoral nerve sheath block for patient-controlled regional analgesia after total knee replacement
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