Abstract:
BACKGROUND:The infusion of local anesthetic in the surgical wound is helpful in the multimodal management of postoperative pain. We hypothesized that local anesthetic wound infusion after cesarean delivery would provide better pain control than epidural morphine analgesia. METHODS:Healthy, term women scheduled for elective cesarean delivery were included in this assessor-blinded, randomized study. Patients were randomly assigned to receive analgesia through a multiorifice wound catheter placed below the fascia and connected to a 5 mL/h ropivacaine 2 mg/mL infusion or an epidural bolus of morphine 2 mg every 12 hours. Both analgesic regimens were continued for 48 hours. The primary outcome was pain at rest at 24 hours postoperatively using the verbal rating score for pain (0-10 scale). Pain intensity, rescue analgesia consumption, and side effects were assessed at 2, 6, 24, and 48 hours after cesarean delivery by an observer blinded to group allocation. Three months after discharge, patient satisfaction, residual pain, and surgical wound complications were assessed. RESULTS:Fifty-eight women participated in the study. At 24 hours, the median rest verbal rating score for pain was 0 (interquartile range: 0-0) in the continuous infusion group and 3 in the epidural morphine group (interquartile range: 2-3; 95% confidence interval of difference: 1-3 units; P < 0.001). The median scores of the 2-, 6-, and 48-hour pain assessments at rest were also lower in the continuous wound infusion group than in the epidural morphine group, and at 2, 6, and 24 hours with movement (P < 0.001). The incidence of nausea, vomiting, pruritus, and urinary retention was significantly lower in the wound infusion group and time to recovery of bowel function was shorter. During the 48-hour follow-up evaluation, the median number of nurse visits attributed exclusively to the analgesic regimen was 1 (interquartile range: 1-2) in the continuous wound infusion group and 8 (interquartile range: 7-10) in the epidural morphine group (95% confidence interval of difference: 6-8 visits; P < 0.001). CONCLUSIONS:Continuous wound infusion with ropivacaine for 48 hours after cesarean delivery was associated with better analgesia, a lower incidence of side effects, less need for nursing care, and shorter duration of stay compared with epidural morphine analgesia.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
O'Neill P,Duarte F,Ribeiro I,Centeno MJ,Moreira Jdoi
10.1213/ANE.0b013e3182368e87subject
Has Abstractpub_date
2012-01-01 00:00:00pages
179-85issue
1eissn
0003-2999issn
1526-7598pii
ANE.0b013e3182368e87journal_volume
114pub_type
杂志文章,随机对照试验abstract::Cardiac output characteristically decreases during trimethaphan infusion but is well maintained or increased during sodium nitroprusside infusion. We postulated that at similar levels of mean arterial pressure, sodium nitroprusside might be associated with greater blood loss than trimethaphan due to the increase in ca...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1980-03-01 00:00:00
abstract::The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and...
journal_title:Anesthesia and analgesia
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abstract:BACKGROUND:Lung isolation with bronchial blockers is a well-described and accepted procedure, often described for use during the management of massive hemoptysis. Recommendations for balloon inflation are sparse, with some advocating for saline whereas other suggest air, including the manufacturers. We sought to evalua...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/ANE.0000000000004397
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abstract::Complement activation and the resulting inflammatory response is an important potential mechanism for multisystem organ injury in cardiac surgery. Novel therapeutic strategies using complement inhibitors may hold promise for improving outcomes for cardiac surgical patients by attenuating complement activation or its b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e3182652b7d
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abstract:UNLABELLED:We investigated the effect of epidural local anesthetic blockade on urinary substance P levels in five patients suffering from painful flare-ups of interstitial cystitis. Urine was collected in 24-h intervals commencing at the onset of an epidural bolus of 0.25% bupivacaine followed by maintenance epidural i...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
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abstract:UNLABELLED:Percutaneous tracheostomy with single-step dilation technique using Griggs' guidewire dilating forceps (GWDF) is a well-recognized procedure. Recently, Ciaglia has introduced a one-step dilation technique using a curved, gradually tapered dilator, the Ciaglia Blue Rhino (CBR). In a prospective, randomized st...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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abstract:BACKGROUND:The impact of physiological adjustments throughout pregnancy on maternal vital signs and laboratory values has yet to be fully defined. The present study was designed to determine the normal range of these parameters among healthy pregnant women during the peripartum period. METHODS:This is a retrospective ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
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abstract::The effects of induction of anesthesia with diazepam and midazolam on baroreflex control of heart rate and on plasma levels of catecholamines were investigated in this study. Group 1 subjects (n = 10) received diazepam, 0.4 mg/kg. Group 2 subjects (n = 10) received midazolam, 0.3 mg/kg. Baroreflex function was assesse...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND:Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal of supratentorial brain tumors du...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2008-02-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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abstract:BACKGROUND:The combination of propofol-remifentanil for procedural deep sedation in spontaneously breathing patients is characterized by the frequent incidence of side effects, especially respiratory depression. These side effects may be due to either the drug combination or the drug delivery technique. Target-controll...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e318198f6dc
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abstract:UNLABELLED:We investigated the role of cardiopulmonary bypass (CPB) in compromised lung function associated with cardiac surgery. Low-frequency respiratory impedance (Zrs) was measured in patients undergoing cardiac surgery with (n = 30; CPB group) or without (n = 29; off-pump coronary artery bypass [OPCAB] group) CPB....
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000055363.23715.40
更新日期:2003-05-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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abstract:BACKGROUND:In this study, we evaluated the feasibility and accuracy of Univent tube (Fuji Systems, Tokyo, Japan) placement with the aid of auscultation (AUS) or as guided by a lighted stylet (LS) compared with placement guided by the fiberoptic bronchoscope (FOB) or the blind intubation technique as recommended by the ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3182025a70
更新日期:2011-02-01 00:00:00
abstract::The hemodynamic effects of esmolol were studied in 40 patients scheduled for elective coronary artery surgery to determine whether the administration of esmolol in chronically beta-blocked patients would result in additional attenuation of sympathetically mediated hemodynamic stress responses to noxious stimuli. Patie...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1987-02-01 00:00:00
abstract:UNLABELLED:We conducted a randomized, controlled, cross-over cadaver study to test the hypothesis that the efficacy of seal for ventilation and airway protection, anatomic position, and airway patency with the flexible laryngeal mask airway (FLMA) are altered by the application of a Boyle Davis (B-D) gag. We also deter...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199907000-00032
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,收录出版
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abstract:BACKGROUND:Aspects of intraoperative management (eg, hypotension) are associated with acute kidney injury (AKI) in noncardiac surgery patients. However, it is unclear if and how the addition of intraoperative data affects a baseline risk prediction model for postoperative AKI. METHODS:With institutional review board (...
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pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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abstract:BACKGROUND:Regional anesthesia is increasingly used in pediatric patients to provide postoperative analgesia and to supplement intraoperative anesthesia. The Pediatric Regional Anesthesia Network was formed to obtain highly audited data on practice patterns and complications and to facilitate collaborative research in ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
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更新日期:2012-12-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:QT interval prolongation is associated with torsades des pointes (TdP), but is a poor predictor of drug torsadogenicity. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall, rather than QT interval prolongation per se. TDR can be measured on th...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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更新日期:2007-02-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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更新日期:1994-05-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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更新日期:2004-03-01 00:00:00
abstract:IMPLICATIONS:This case describes the impact of argatroban and off-pump coronary revascularization on hemostasis as assessed by conventional hemostatic measures and Thrombelastography in a patient with heparin-induced thrombocytopenia. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Ten to fifteen percent of awake patients develop neurological deficits secondary to cerebral hypoperfusion after carotid artery cross-clamping. The reversal of such deficits by increasing the inspired oxygen fraction (Fio(2)) has been demonstrated, and regional cerebral oxygenation (rSO(2)) has been shown to...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181c5f160
更新日期:2010-02-01 00:00:00
abstract::Cardiopulmonary bypass (CPB) impairs pulmonary endothelial injury in part by increasing expression of adhesion molecules that results in neutrophil influx. Although numerous proinflammatory cytokines up-regulate these responses, the extent to which systemic and pulmonary proinflammatory cytokines increase remains unkn...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200005000-00008
更新日期:2000-05-01 00:00:00