Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.


BACKGROUND:The purpose of this study was to determine whether either regional anesthesia (RA) or general anesthesia (GA) provided the best analgesia with the fewest adverse effects up to 2 weeks after ambulatory hand surgery. METHODS:Patients undergoing ambulatory hand surgery were randomly assigned to RA (axillary brachial plexus block; n = 50) or GA (n = 50). Before surgery, all patients rated their hand pain (visual analog scale) and pain-related disability (Pain-Disability Index). After surgery, eligibility for bypassing the postanesthesia care unit ("fast track") was determined, and pain, adverse effects, and home-readiness scores were measured. On postoperative days 1, 7, and 14, patients documented their pain, opioid consumption, adverse effects, Pain-Disability Index, and satisfaction. RESULTS:More RA patients were fast-track eligible (P < 0.001), whereas duration of stay in the postanesthesia care unit was shorter in the RA group (P < 0.001). Time to first analgesic request was longer in the RA group (P < 0.001), and opioid consumption was reduced before discharge (P < 0.001). In the RA group, the pain ratings measured at 30, 60, 90, and 120 min after surgery were lower (P < 0.001), and patients spent less time in the hospital after surgery (P < 0.001). More GA patients experienced nausea/vomiting during recovery in the hospital (P < 0.05). However, on postoperative days 1, 7, and 14, there were no differences in pain, opioid consumption, adverse effects, Pain-Disability Index, or satisfaction. CONCLUSIONS:Despite significant reduction in pain before discharge from the hospital after ambulatory hand surgery, single-shot axillary brachial plexus block does not reduce pain at home on postoperative day 1 or up to 14 days after surgery when compared with GA. However, RA does provide other significant early benefits, including reduction in nausea and faster discharge from the hospital.






McCartney CJ,Brull R,Chan VW,Katz J,Abbas S,Graham B,Nova H,Rawson R,Anastakis DJ,von Schroeder H




Has Abstract


2004-08-01 00:00:00














  • Developmental toxicity of nondepolarizing muscle relaxants in cultured rat embryos.

    abstract::Evidence of developmental toxicity of clinically used nondepolarizing muscle relaxants was sought in rat embryos grown in culture. Embryos were explanted at 8 AM on day 9 of gestation (presomite stage, plug day = day 0), and were cultured in rotating bottles with medium containing various concentrations of d-tubocurar...


    pub_type: 杂志文章


    authors: Fujinaga M,Baden JM,Mazze RI

    更新日期:1992-06-01 00:00:00

  • Dose-response relationship of intrathecal morphine for postcesarean analgesia.

    abstract:BACKGROUND:This series investigated the quality of analgesia and the incidence and severity of side effects of intrathecal morphine for post-cesarean analgesia administered over a dose range of 0.0-0.5 mg. METHODS:ONE hundred eight term parturients undergoing cesarean delivery at term and given spinal anesthesia were ...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Palmer CM,Emerson S,Volgoropolous D,Alves D

    更新日期:1999-02-01 00:00:00

  • Interaction of halogenated anesthetics with alpha- and beta-adrenoceptor stimulations in diabetic rat myocardium.

    abstract:BACKGROUND:Halogenated anesthetics potentiate the positive inotropic effects of alpha- and beta-adrenoceptor stimulations. Although diabetes mellitus induces significant myocardial abnormalities, the interaction of halogenated anesthetics and adrenoceptor stimulation in diabetic myocardium remains unknown. METHODS:Lef...


    pub_type: 杂志文章


    authors: Amour J,David JS,Vivien B,Coriat P,Riou B

    更新日期:2004-11-01 00:00:00

  • Population pharmacokinetics and pharmacodynamics of thiopental: the effect of age revisited.

    abstract::The authors have previously attributed the mechanism for the 50-67% decrease in the required dose of thiopental for induction of anesthesia in aged human patients to a decrease in the initial distribution volume for thiopental. Using a larger group of patients and volunteers studied in the laboratory, the authors have...


    pub_type: 杂志文章


    authors: Stanski DR,Maitre PO

    更新日期:1990-03-01 00:00:00

  • Soluble complement receptor type 1 inhibited the systemic organ injury caused by acid instillation into a lung.

    abstract:BACKGROUND:Acid aspiration into one lung causes contralateral lung injury and systemic organ injury; this injury is thought to be mediated by the sequestration of activated neutrophils. Recombinant human soluble complement receptor 1 (sCR1) inhibits both the classical and alternative complement pathways; this study inv...


    pub_type: 杂志文章


    authors: Nishizawa H,Yamada H,Miyazaki H,Ohara M,Kaneko K,Yamakawa T,Wiener-Kronish J,Kudoh I

    更新日期:1996-11-01 00:00:00

  • Halothane and isoflurane alter the Ca2+ binding properties of calmodulin.

    abstract:BACKGROUND:Ca2+ plays an important role in signal transduction and anesthetic mechanisms. To date, no one has observed a direct effect of volatile anesthetics on a Ca(2+)-binding protein. We therefore examined the effects of halothane and isoflurane on the Ca(2+)-binding properties of bovine brain calmodulin. METHODS:...


    pub_type: 杂志文章


    authors: Levin A,Blanck TJ

    更新日期:1995-07-01 00:00:00

  • Midazolam: effects on amnesia and anxiety in children.

    abstract:BACKGROUND:The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administrat...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kain ZN,Hofstadter MB,Mayes LC,Krivutza DM,Alexander G,Wang SM,Reznick JS

    更新日期:2000-09-01 00:00:00

  • Onset of maximum neuromuscular block following succinylcholine or vecuronium in four age groups.

    abstract:BACKGROUND:Increasing age appears to be associated with a slower onset of neuromuscular blockade, but such an effect has not been studied with the same doses of the same drugs across pediatric and adult age groups. METHODS:The authors measured the evoked compound action potential of the adductor pollicis muscle in res...


    pub_type: 杂志文章


    authors: Koscielniak-Nielsen ZJ,Bevan JC,Popovic V,Baxter MR,Donati F,Bevan DR

    更新日期:1993-08-01 00:00:00

  • Functional magnetic resonance imaging studies of pain: an investigation of signal decay during and across sessions.

    abstract:BACKGROUND:Several investigations into brain activation caused by pain have suggested that the multiple painful stimulations used in typical block designs may cause attenuation over time of the signal within activated areas. The effect this may have on pain investigations using multiple tasks has not been investigated....


    pub_type: 杂志文章


    authors: Ibinson JW,Small RH,Algaze A,Roberts CJ,Clark DL,Schmalbrock P

    更新日期:2004-10-01 00:00:00

  • Binding of thiopental to plasma proteins: effects on distribution in the brain and heart.

    abstract::Thiopental-14C (30 mg and 10 muCi/kg) was injected intravenously into rats 36-48 hours following bilateral nephrectomy and one minute after pretreatment with sulfadimethoxine (30 mg/kg, iv). Control groups of normal and sham-operated animals were used. The distributions of radioactivity in plasma, brain, and heart 1, ...


    pub_type: 杂志文章


    authors: Ghoneim MM,Pandya HB,Kelley SE,Fischer LJ,Corry RJ

    更新日期:1976-12-01 00:00:00

  • Influence of mannitol and furosemide, alone and in combination, on brain water content after fluid percussion injury.

    abstract:BACKGROUND:Furosemide and mannitol are used to reduce intracranial pressure, but the impact of furosemide on edema of injured brain is unclear. The authors examined the effects of furosemide and mannitol, alone and in combination, on brain water content in brain-injured rats. METHODS:Anesthetized rats were subjected t...


    pub_type: 杂志文章


    authors: Todd MM,Cutkomp J,Brian JE

    更新日期:2006-12-01 00:00:00

  • A comparison of obstetric and nonobstetric anesthesia malpractice claims.

    abstract::Malpractice claims filed against anesthesiologists for care involving obstetric (OB) anesthesia (n = 190) were taken from the American Society of Anesthesiologists' Closed Claims Database and compared to claims not involving OB cases (n = 1351). The most common complications in the OB claims were (percentage of all OB...


    pub_type: 杂志文章


    authors: Chadwick HS,Posner K,Caplan RA,Ward RJ,Cheney FW

    更新日期:1991-02-01 00:00:00

  • Isoflurane and the pulmonary vascular pressure-flow relation at baseline and during sympathetic alpha- and beta-adrenoreceptor activation in chronically instrumented dogs.

    abstract:BACKGROUND:The extent to which isoflurane anesthesia alters systemic vascular regulation has received considerable attention. In contrast, the pulmonary vascular effects of isoflurane have not been elucidated. Our initial objective was to investigate the net effect of isoflurane on the baseline left pulmonary vascular ...


    pub_type: 杂志文章


    authors: Lennon PF,Murray PA

    更新日期:1995-03-01 00:00:00

  • Halothane and isoflurane differentially affect the regulation of dopamine and gamma-aminobutyric acid release mediated by presynaptic acetylcholine receptors in the rat striatum.

    abstract:BACKGROUND:General anesthetics are thought to produce their hypnotic effects mainly by acting at ligand-gated ionic channels in the central nervous system (CNS). Although it is well established that volatile anesthetics significantly modify the activity of the acetylcholine nicotinic receptors of the neuromuscular junc...


    pub_type: 杂志文章


    authors: Salord F,Keita H,Lecharny JB,Henzel D,Desmonts JM,Mantz J

    更新日期:1997-03-01 00:00:00

  • Intrathecal sufentanil for labor analgesia does not cause a sympathectomy.

    abstract:BACKGROUND:Intrathecal sufentanil (ITS) is frequently used to provide analgesia during labor. Decreases in blood pressure and sensory changes in this circumstance suggest that ITS may have a local anesthetic effect and thus cause a sympathectomy. To determine whether ITS given to laboring women causes a sympathectomy, ...


    pub_type: 杂志文章


    authors: Riley ET,Walker D,Hamilton CL,Cohen SE

    更新日期:1997-10-01 00:00:00

  • Alterations in the functional connectivity of frontal lobe networks preceding emergence delirium in children.

    abstract:BACKGROUND:This study aimed to characterize the electroencephalogram in children who emerged with emergence delirium (ED) compared with children without ED using methods that involved the assessment of cortical functional connectivity. METHODS:Children aged 5 to 15 yr had multichannel electroencephalographic recording...


    pub_type: 杂志文章


    authors: Martin JC,Liley DT,Harvey AS,Kuhlmann L,Sleigh JW,Davidson AJ

    更新日期:2014-10-01 00:00:00

  • Direct assessments of the antioxidant effects of propofol medium chain triglyceride/long chain triglyceride on the brain of stroke-prone spontaneously hypertensive rats using electron spin resonance spectroscopy.

    abstract:BACKGROUND:Antioxidant anesthetics such as propofol (2,6-diisopropylphenol) directly inhibit lipid peroxidation via the generation of reactive oxygen species. Currently, there are no other studies regarding the direct effects of propofol medium chain triglyceride/long chain triglyceride (MCT/LCT) on reactive oxygen spe...


    pub_type: 杂志文章


    authors: Kobayashi K,Yoshino F,Takahashi SS,Todoki K,Maehata Y,Komatsu T,Yoshida K,Lee MC

    更新日期:2008-09-01 00:00:00

  • A simplified gas chromatographic method for quantifying the sevoflurane metabolite hexafluoroisopropanol.

    abstract:BACKGROUND:The results of sevoflurane biotransformation (fluoromethyl-1,1,1,3,3,3,-hexafluoro-2-propyl ether) to inorganic fluoride have been examined. However, these investigations have lacked a simplified assay for determining the primary organic metabolite, hexafluoroisopropanol. Previous attempts have involved exte...


    pub_type: 杂志文章


    authors: Morgan SE,Frink EJ,Gandolfi AJ

    更新日期:1994-01-01 00:00:00

  • Combination of a δ-opioid Receptor Agonist and Loperamide Produces Peripherally-mediated Analgesic Synergy in Mice.

    abstract:BACKGROUND:The long-term use of opioids for analgesia carries significant risk for tolerance, addiction, and diversion. These adverse effects are largely mediated by μ-opioid receptors in the central nervous system. Based on the authors' previous observation that morphine and δ-opioid receptor agonists synergize in spi...


    pub_type: 杂志文章


    authors: Bruce DJ,Peterson CD,Kitto KF,Akgün E,Lazzaroni S,Portoghese PS,Fairbanks CA,Wilcox GL

    更新日期:2019-09-01 00:00:00

  • Effects of halothane and isoflurane on hyperexcitability of spinal dorsal horn neurons after incision in the rat.

    abstract:BACKGROUND:The aim of this study was to determine whether halothane and isoflurane used during and after surgical injury attenuate subsequent hyperexcitability of spinal dorsal horn (SDH) neurons by preventing development of central sensitization. METHODS:Activity of a wide-dynamic-range neuron of the SDH was isolated...


    pub_type: 杂志文章


    authors: Kawamata M,Narimatsu E,Kozuka Y,Takahashi T,Sugino S,Niiya T,Namiki A

    更新日期:2005-01-01 00:00:00

  • Halothane and enflurane constrict canine mesenteric arteries by releasing Ca2+ from intracellular Ca2+ stores.

    abstract:BACKGROUND:Recent studies suggest that volatile anesthetics cause not only vasodilation but also vasoconstriction, depending on the experimental conditions. However, the mechanism of the constrictive effect of volatile anesthetics has not been clarified. The aim of this study was to evaluate the vasoconstrictor effects...


    pub_type: 杂志文章


    authors: Kakuyama M,Hatano Y,Nakamura K,Toda H,Terasako K,Nishiwada M,Mori K

    更新日期:1994-05-01 00:00:00

  • Anesthetic techniques for fetal surgery: effects of maternal anesthesia on intraoperative fetal outcomes in a sheep model.

    abstract:BACKGROUND:Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal-fetal hemodynamic instability and fetal myocardial depression. The authors' preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane sup...


    pub_type: 杂志文章


    authors: Ngamprasertwong P,Michelfelder EC,Arbabi S,Choi YS,Statile C,Ding L,Boat A,Eghtesady P,Holland K,Sadhasivam S

    更新日期:2013-04-01 00:00:00

  • Effects of volatile anesthetics on acetylcholine-induced relaxation in the rabbit mesenteric resistance artery.

    abstract:BACKGROUND:Vascular endothelium plays an important role in the regulation of vascular tone. Volatile anesthetics have been shown to attenuate endothelium-mediated relaxation in conductance arteries, such as aorta. However, significant differences in volatile anesthetic pharmacology between these large vessels and the s...


    pub_type: 杂志文章


    authors: Akata T,Nakashima M,Kodama K,Boyle WA 3rd,Takahashi S

    更新日期:1995-01-01 00:00:00

  • Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans.

    abstract:BACKGROUND:In animals, systemic and intrathecal administration of the alpha2 -adrenergic receptor agonist dexmedetomidine results in robust antinociceptive effects in models of heat pain. In humans, systemically administered dexmedetomidine is approved for sedating patients in the intensive care unit. However, whether ...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Angst MS,Ramaswamy B,Davies MF,Maze M

    更新日期:2004-09-01 00:00:00

  • Development and validation of a risk quantification index for 30-day postoperative mortality and morbidity in noncardiac surgical patients.

    abstract:BACKGROUND:Optimal risk adjustment is a requisite precondition for monitoring quality of care and interpreting public reports of hospital outcomes. Current risk-adjustment measures have been criticized for including baseline variables that are difficult to obtain and inadequately adjusting for high-risk patients. The a...


    pub_type: 杂志文章,随机对照试验


    authors: Dalton JE,Kurz A,Turan A,Mascha EJ,Sessler DI,Saager L

    更新日期:2011-06-01 00:00:00

  • Presynaptic inhibition in man during anesthesia and sleep.

    abstract::The slow positive (P2) wave of the evoked electrospinogram was recorded from the dorsal epidural space in man. The waveform characteristics of the P2 wave were similar to those of the dorsal cord positive wave (P wave), which is believed to be caused by the primary afferent depolarization (PAD) and to be related to pr...


    pub_type: 杂志文章


    authors: Shimoji K,Ito Y,Oama K,Sawa T,Ikezono E

    更新日期:1975-10-01 00:00:00

  • Contribution of the chemokine (C-C motif) ligand 2 (CCL2) to mechanical hypersensitivity after surgical incision in rats.

    abstract:BACKGROUND:Neural glial signaling in the spinal cord may underlie pain and sensitization after peripheral injury. The authors test the role of a glial activator, the chemokine (C-C motif) ligand 2 (CCL2), on mechanical hypersensitivity after plantar incision in a rat model of postoperative pain. METHODS:Twenty-four ho...


    pub_type: 杂志文章


    authors: Peters CM,Eisenach JC

    更新日期:2010-05-01 00:00:00

  • Effect of low-dose droperidol on the QT interval during and after general anesthesia: a placebo-controlled study.

    abstract:BACKGROUND:Since the effects of antiemetic doses of droperidol on the QT interval have not been previously studied, the authors designed a randomized, double-blind, placebo-controlled study to evaluate the intraoperative and postoperative effects of small-dose droperidol (0.625 and 1.25 mg intravenous) on the QT interv...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: White PF,Song D,Abrao J,Klein KW,Navarette B

    更新日期:2005-06-01 00:00:00

  • The pharmacodynamics and pharmacokinetics of vecuronium in patients anesthetized with isoflurane with normal renal function or with renal failure.

    abstract::The duration of action and the pharmacokinetics of vecuronium were compared in patients with and without renal function. Twenty patients were studied: 12 with renal failure who were to receive kidney transplants from cadaveric donors, and eight with normal renal function. After oral premedication with diazepam, 10 mg,...


    pub_type: 杂志文章


    authors: Lynam DP,Cronnelly R,Castagnoli KP,Canfell PC,Caldwell J,Arden J,Miller RD

    更新日期:1988-08-01 00:00:00

  • Pulsus alternans during general anesthesia with halothane: effects of permissive hypercapnia.

    abstract:BACKGROUND:Pulsus alternans is a classic type of abnormal pulse. It can be defined as a regular alternation of pulse amplitude in which runs of weak and strong beats follow each other alternatively without any change in cycle length. It may be a sign of severe decompensated congestive heart failure. The authors infrequ...


    pub_type: 杂志文章


    authors: Saghaei M,Mortazavian M

    更新日期:2000-07-01 00:00:00