Our results show that about 35% of day-surgery patients experience moderate-to-severe pain at home in spite of analgesic medication. About 20% of patients had sleep problems due to severe pain. However, only 5% of patients were dissatisfied. Better analgesic techniques are necessary for patients undergoing certain types of surgery. Patient information and follow-up routines need to be improved.
Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.
Levels of sensory (pinprick) and somatic motor blockade were measured in a double-blind study of 30 volunteers given single epidural injections of 1%, 0.75%, and 0.5% ropivacaine. Onset of analgesia was rapid with all concentrations (7-10 min). Maximal levels of analgesia were established 60 min after injection, with no significant differences in the maximal median cephalad spread. Duration of analgesia at the T-12 level and total duration were significantly longer with 1% and 0.75% than with 0.5% ropivacaine. Motor blockade was assessed by a quantitative method (measurements of isometric muscle force) and a qualitative method (modified Bromage scale). Onset of motor blockade measured by the quantitative method was significantly slower with 0.5% ropivacaine than with the higher concentrations. Maximal muscle weakness occurred 1-1.5 h after injection with all three concentrations. With increase in ropivacaine dose from 100 to 200 mg, the intensity and duration of motor blockade increased. Muscles involved in knee extension were blocked most, those of plantar flexion least. Recovery of motor function, assessed by the above-mentioned quantitative method, occurred simultaneously with the recovery of pinprick perception. Motor blockade registered by Bromage scale showed a slower onset for 0.5% ropivacaine than for the higher concentrations. Mean durations of grade 1 and 2 block were longest for the 1% solution. Motor blockade described by the Bromage scale showed only the first part of the regression phase. Full recovery of muscle strength (Bromage scale = 0) was attained 1.5-2.5 h earlier than assessed by the quantitative method. No adverse effects were registered.
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