In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.
We conducted a randomized, double-blind, controlled study in patients undergoing day-case knee arthroscopy to evaluate the analgesic effect, for 36 h after operation, of the addition of either 2 mg or 5 mg of morphine to intra-articular bupivacaine. Patients in group BM5 (n = 20) received 0.25% bupivacaine 40 ml with morphine 5 mg; patients in group BM2 (n = 20) received 0.25% bupivacaine 40 ml with morphine 2 mg and patients in group B0 (n = 18) received 0.25% bupivacaine 40 ml only. The drugs were given by intra-articular injection by the surgeon at the end of the operation and the tourniquet released 10 min later. Preoperative and postoperative pain was assessed over the ensuing 36 h, at rest and with movement, using a 100-mm visual analogue scale. There were no significant differences in pain scores, consumption of additional analgesia, or time to first request for analgesia between any of the groups. We conclude that, after day-case knee arthroscopy, no additional analgesic effect was afforded by the addition of morphine to intra-articular bupivacaine.
Background
Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing sympathetic nervous system activity, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage.
Methods
The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 ± 0.8°C) or normothermia (n = 501, 36.7 ± 0.5°C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, etc.) were prospectively followed until 3 month follow-up and were compared between hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function.
Results
There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in post- vs. preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 μg/L) whereas normothermic patients had a small postoperative increase (median change + 0.01 μg/L, P = 0.038).
Conclusion
In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.
The role of hyaluronidase on the onset time and quality of single quadrant sub-Tenon's block was studied in a prospective, randomized, double-blind controlled manner. One hundred and twenty consecutive patients undergoing cataract surgery under local anaesthesia received a sub-Tenon's block with either of two local anaesthetic solutions. One consisted of 2% plain lignocaine 3 ml with 0.5% plain bupivacaine 2 ml. The other consisted of 2% lignocaine 1 ml containing 150 IU per ml of hyaluronidase with 2% plain lignocaine 2 ml and 0.5% plain bupivacaine 2 ml. The development of akinesia and the resulting block quality were assessed. Akinesia scores were lower at all time intervals and were significantly lower (P<0.05) up to 9 minutes after block in the hyaluronidase group. However, block quality as assessed by the surgeon was not significantly different between the groups. The addition of 150 IU hyaluronidase significantly speeds up the onset of surgical anaesthesia produced by a sub-Tenon's block.
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