Background and Aims Major spinal surgery is a painful procedure requiring very high doses of intraoperative and postoperative opioids [1]. The majority of patients wake up in severe pain with many experiencing side effects from high opiate use [2]. Our primary aim was to investigate if an intraoperative intravenous infusion of ketamine and lidocaine mixture, when added to TIVA practice, improves pain scores in recovery and decreases the opioid amount used perioperatively.Both groups received perioperative Multimodal Analgesia MMA: Paracetamol, Clonidine, Magnesium Sulphate and Ketamine boluses (only for the first group, as for the second, Ketamine was added to the infusion). Methods A retrospective review of the medical records of patients undergoing major spinal surgery at RNOH was conducted.The patients were divided into two groups based on the type of main medications received:. Group 1: MMA plus Opioids . Group 2: MMA plus Opioids plus KLI Opioid doses were converted to morphine equivalents daily doses. Results Pain scores were significantly lower in Group 2, on average, 3 points lower than in Group 1. The opioid doses used in the Group 2 were over 3 times lower than those observed in Group 1. Median opioid dose for the first group was 24 [IQR 12,33] compared to median of 6 [IQR 0,18] for Group 2.Median time to wake up was 3 minutes in Group 2 compared to 20 mins in Group 1.
morphine use and pain scores between patients with a suprainguinal fascia iliaca block (FIB) with ropivacaine 0.375%, 40 mL and a control group (NB). Methods We conducted a retrospective, single-center study reviewing all data of elective total hip arthroplasties performed between April 2019 and May 2021. Primary endpoint is patient-controlled intravenous (PCIA) morphine use at 24 hours. Secondary endpoints were PCIA morphine use at 48 hours, NRS pain scores, perioperative sufentanil-, postoperative IV piritramide consumption on the PACU ward and nausea. The ethical committee of the Imelda hospital in Bonheiden deemed ethical approval unnecessary. Results Our study included 277 patients, consisting of 203 patients in the FIB group and 74 in the NB group. There was a significant decrease in PCIA morphine use (p = 0,000034) at 24 hours, lower pain scores at 48 hours (p = 0,0003) and lower sufentanil consumption perioperatively (p = 0,015) in the FIB group. However, pain scores and piritramide consumption in the PACU ward were significantly increased (p = 0,02 and p = 0,014, respectively) in the same group. No difference was reported for PCIA morphine use at 48 hours, pain scores at 24 hours and nausea.
Background and study aim: Revision of total hip arthroplasty (rTHA) is associated with significant blood loss. We have used intraoperative cell savage (ICS) systematically in these patients for the last ten years. We sought to determine how often re-suspended red blood cells could be re-transfused and to identify predictors of re- transfusion. Materials and methods: Patients who underwent aseptic rTHA between January 2011 and December 2020 at our center were enrolled in this retrospective observational study. Exclusion criteria were revision for infection or tumor. The primary outcome was the successful use of ICS defined as the ability to re-transfuse at least 125 mL of ICS blood. Secondary outcome measures included re-transfused ICS blood volume, aspirated blood volume, allogenic blood transfusion, and post-operative hemoglobin level. Uni- and multi-variable logistic regressions were used to identify patients and procedure characteristics associated with successful ICS. Mann-Whitney U tests, Student’s t tests and Chi-square tests were used to compare outcomes between patients with and without successful ICS. A P value < 0.05 was considered statistically significant. Results: ICS was successful in 93 (69.9%) out of 133 patients. The extent of revision, categorized as isolated acetabulum, isolated femur, or combined revision was the only predictor of successful ICS. Postoperative hemoglobin levels as well as rate and amount of allogenic red blood cells transfusion did not differ between the groups. Conclusions: ICS is useful in most patients undergoing rTHA. Those requiring a combined revision have the greatest chance of successful re-infusion.
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