BackgroundGlycopyrrolate given as reversing agents of muscle relaxants has been reported to be effective in reducing postoperative catheter-related bladder discomfort (CRBD). However, it remains unclear whether glycopyrrolate as premedication is also effective. This study aims to investigate the effectiveness of glycopyrrolate as premedication on preventing CRBD in the post-anesthesia care unit (PACU).MethodsEighty-three patients who received elective ureteroscopic removal of ureteral stone were randomly assigned to the control (n = 43) or the glycopyrrolate group (n = 40). The glycopyrrolate group was treated with glycopyrrolate 0.3 mg as premedication while the control group received 0.9% saline 1.5 ml. The incidence and severity of CRBD and pain score using numerical rating scale (NRS) were measured in the PACU.ResultsThe incidence of CRBD (26 of 40 patients vs. 41 of 43 patients, relative risk [RR] = 0.68, 95% Confidence interval [CI] = 0.53–0.86, P = 0.001) and the moderate to severe CRBD incidence (6 of 40 patients vs. 20 of 43 patients, RR = 0.32, 95% CI = 0.14–0.72, P = 0.002) were lower in the glycopyrrolate group than in the control group. Also, postoperative pain NRS score was found to be lower in the glycopyrrolate group (median = 1 [Q1 = 0, Q3 = 2]) compared to the control group (3 [1, 5], median difference = 1.00, 95% CI = 0.00–2.00, P = 0.002).ConclusionsThe use of glycopyrrolate 0.3 mg as premedication in patients receiving ureteroscopic removal of ureteral stone reduced the incidence and severity of CRBD, and decreased postoperative pain in the PACU.
BackgroundPatients who undergo urinary catheterization may experience postoperative catheter-related bladder discomfort (CRBD). Previous studies have indicated that drugs with antimuscarinic effects could reduce the incidence and severity of CRBD. Accordingly, this study was carried out to investigate whether nefopam, a centrally acting analgesic with concomitant antimuscarinic effect, reduces the incidence and severity of CRBD.MethodsSixty patients with American Society of Anesthesiologists physical status I and II and aged 18–70 years who were scheduled to undergo elective ureteroscopic litholapaxy participated in this double-blinded study. Patients were divided into control and nefopam groups, comprising 30 patients each. In the nefopam group, 40 mg nefopam in 100 ml of 0.9% saline was administered intravenously. In the control group, only 100 ml of 0.9% saline was administered. All patients had a urethral catheter and ureter stent inserted during surgery. The incidence and severity of CRBD, numerical rating scale (NRS) score of postoperative pain, rescue pethidine dose, and side effects were recorded in the post-anesthesia care unit after surgery.ResultsThe incidence (P = 0.020) and severity (P < 0.001) of CRBD were significantly different between the control group and the nefopam group. The NRS score of postoperative pain (P = 0.006) and rescue dose of pethidine (P < 0.001) were significantly higher in the control group than in the nefopam group.ConclusionsIntravenous administration of nefopam in patients scheduled to undergo ureteroscopic litholapaxy reduced the incidence and severity of CRBD, NRS score of postoperative pain and analgesic requirements.
Meralgia paresthetica (MP) is a neuropathic pain caused by entrapment of the lateral femoral cutaneous nerve (LFCN), leading to pain, tingling sensation, and numbness in the anterolateral aspect of the thigh. MP has an incidence rate of 4.3 per 10,000 person-years in the general populations. It has been reported to be associated with obesity, diabetes mellitus (DM), prolonged surgical time, and other entrapment etiologies including pregnancy, wearing tight clothes, and leaning against hard objects [1,2]. It is also suspected that these patients develop MP due to direct compression of the LFCN in the prone position. When a hemorrhoid surgery is conducted in the jack-knife position, the weight of the abdominal viscera and adipose tissue may be subject to greater traction forces, resulting in increased compression of the LFCN. MP may develop in severe obese patients even if with short surgical time.To the best of our knowledge, this case report would be the first case of MP due to the jack knife position assumed in hemorrhoid surgery. CASE REPORTA 42-year-old man (height 176 cm; weight 140 kg; body mass index [BMI] 41.6 kg/m 2 ) diagnosed with hemorrhoids, underwent hemorrhoidectomy surgery. The patient had a history of hypertension, diabetes, heart failure, and restless leg syndrome (RLS). He was under treatment with antidepressants, including a selective serotonin receptor inhibitor (SSRI) and benzodiazepines (BZD), along with antihypertensive drugs. Initially, surgery under spinal anesthesia in a jack-knife position was planned. Considering the BMI of the patient, a blind saddle block was attempted; unfortunately, it failed. Following this, an ultrasonography-guided spinal
Greater auricular nerve neuropathy is a reported as complication in some cases of shoulder arthroscopy in the beach chair position using a horse-shoe headrest. Due to this risk, intubation pad-type headrest is recommended for the beach chair position, to effectively prevent greater auricular nerve palsy. In this case report, we described a patient who experienced greater auricular nerve neuropraxia after open reduction and internal fixation with plate of clavicular fracture in beach chair position using an intubation pad-type headrest. A 49-year-old man was diagnosed with left clavicular fracture without accompanying injury or complication. He underwent an operation for open reduction and internal fixation with a plate. After surgery, the patient reported numbness, and a tingling sensation without pain or skin lesion in the auricular area and the lower margin of the left mandible. Based on the clinical symptoms, greater auricular nerve neuropraxia was diagnosed. The symptoms disappeared completely after four weeks of outpatient follow-up. and parotid gland [6,7]. Compression nerve injury from usage of a horse-shoe headrest or a standard universal headrest was the cause of GAN injury in three cases reported previously.However, greater auricular nerve neuropraxia (GANN) has not been previously reported in beach chair positioning using intubation pad-type headrest (Fig. 1).Herein, we reported a case of GANN following beach chair positioning using an intubation pad-type headrest with review of the relevant literature. CASE REPORTA 49-year-old Asian man was diagnosed with left clavicular fracture due to a fall from a bicycle. The patient had no surgical or medical history; and there was no accompanying injury or complication. The patient was scheduled for open reduction and internal fixation with a plate.The surgery was performed under general anesthesia. In the operating room, the patient was monitored for electrocardiography, pulse oximetry, non-invasive blood pressure, and bispectral index. Anesthesia induction was with fentanyl 100 g, propofol 120 mg, and rocuronium 50 mg. After muscle relaxation, the patient was intubated with an 8 mm-cuffed oral ■Case Report■
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