Abstract:
BACKGROUND:Bilateral breast augmentation is an increasingly popular day-case procedure. Local infiltration with sedation is routinely used for its ease of application compared with the more complex and potentially riskier paravertebral blockade (PVB). We hypothesized that ropivacaine injected by experienced anesthesia providers into the paravertebral space as a PVB was more effective than ropivacaine injected by the operating surgeon (plastic surgeon) directly into the zone of surgical dissection. METHODS:Forty female patients who were ASA physical status I or II and undergoing bilateral subpectoral cosmetic breast augmentation were recruited for participation in a prospective, randomized, single-blind study. Patients were randomized to 1 of 2 groups: ropivacaine via PVB, or surgical infiltration of ropivacaine. In both groups, the surgeon was asked to infiltrate the appropriate area with either saline (PVB group) or ropivacaine (local infiltration group). Both groups were sedated with propofol, titrated to effect. The plastic surgeon was blinded to the solution injected. Data collected included demographic characteristics, intraoperative cooperation scores, recovery room postoperative nausea and vomiting, analgesia use, and visual analog scale pain scores. All patients were asked to complete a preoperative anxiety and quality of recovery questionnaire and to record their pain scores and analgesia requirements on discharge. The outcome measures were (i) intraoperative patient cooperation as assessed by the plastic surgeon, (ii) propofol requirement, (iii) postoperative pain, and (iv) quality of recovery. RESULTS:Forty patients completed the study. PVB improved intraoperative cooperation (significance of difference P < 0.001, WMWodds = 6.69 with 95% 1-sided confidence interval CI ≥2.85), reduced propofol requirement (significance of difference P = 0.005, WMWodds = 0.35, CI <0.69), and decreased average postoperative pain in the home environment (significance of difference P = 0.007, WMWodds = 0.38, CI <0.73). There were no PVB complications. Only patients from the surgical infiltration group required rescue analgesics (30%, significance of difference = 0.01). CONCLUSIONS:In a limited number of patients, we found that PVB is superior to direct surgical infiltration of ropivacaine for bilateral breast augmentation in same-day surgery. These advantages need to be balanced against the potential risks of PVB, especially in an office setting.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Gardiner S,Rudkin G,Cooter R,Field J,Bond Mdoi
10.1213/ANE.0b013e318264ba33subject
Has Abstractpub_date
2012-11-01 00:00:00pages
1053-9issue
5eissn
0003-2999issn
1526-7598pii
ANE.0b013e318264ba33journal_volume
115pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Heart rate variability might predict arrhythmias after coronary artery bypass grafting. METHODS:Off-line processing of 10-min electrocardiogram recordings of consecutive patients provided R-R intervals for time domain, frequency domain, Poincaré, and point correlation analyses and subsequent association wit...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000239330.45658.76
更新日期:2006-11-01 00:00:00
abstract::Epidural clonidine produces analgesia in humans with acute and chronic pain. Its use is limited because of short-lasting analgesia, hemodynamic depression, sedation, and respiratory depression. Intrathecal guanfacine has a longer duration of action than intrathecal clonidine. The present study compares these two drugs...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1992-05-01 00:00:00
abstract::The performance of five of the most commonly used halothane vaporizers and three enflurane vaporizers was tested under conditions encountered in low-flow and closed-circuit anesthesia. Anesthetic gas concentrations were measured continuously with a mass spectrometer connected to a circle system. The results indicated ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1980-05-01 00:00:00
abstract::Vecuronium (Org NC 45) was used in 27 parturients undergoing elective cesarean section under general anesthesia. One of the parturients had a twin pregnancy. Neuromuscular transmission was assessed clinically by stimulating the ulnar nerve and observing the contraction of the fingers. An initial bolus of 0.05 mg . kg-...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-10-01 00:00:00
abstract::There are no studies evaluating S(+)-ketamine for pain management after sternotomy. In this prospective, randomized, double-blind, placebo-controlled clinical trial, we evaluated the efficacy and feasibility of S(+)-ketamine as an adjunctive analgesic after cardiac surgery. Ninety patients scheduled for elective coron...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000133913.07342.B9
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:When temporary arterial occlusion of the parent artery is difficult for anatomical reasons, or when inadvertent aneurysmal rupture occurs during surgical dissection, adenosine administration can be used to produce flow arrest and brief, profound systemic hypotension that can facilitate intracranial aneurysm ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182a6d31b
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Risk of intraoperative hypothermia is relatively high in middle-aged and elderly patients undergoing curative resection of esophageal cancer, which may cause myocardial ischemia during the early postoperative period. The objective of this study was to compare aggressive or standard body temperature managemen...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000004022
更新日期:2019-08-01 00:00:00
abstract:UNLABELLED:Although isoflurane is a known vasodilator, the mechanism of isoflurane-induced vasodilation is not clear. One of the most important systems in this context is the nitric oxide (NO)-mediated vasodilation. The activity of this system is regulated by the agonist-induced Ca(2+) influx rather than Ca(2+) release...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000068826.97781.ce
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Operating rooms contribute significantly to the increasing volumes and costs of hospital waste. Little is known, however, about doctors' views of hospital waste recycling despite their potential influence in improving recycling programs. We surveyed the waste recycling views held by anesthesiologists in Aust...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31824d273d
更新日期:2012-05-01 00:00:00
abstract:UNLABELLED:Linking physiological pharmacokinetic models to models of the cardiovascular system requires knowledge of the sites in the body that mediate a drug's cardiovascular effects. We examined the role of the coronary concentrations of propofol. Nine sheep anesthetized with isoflurane (2%) were instrumented acutely...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000060561.16583.a7
更新日期:2003-06-01 00:00:00
abstract::Although amrinone produces thrombocytopenia, no information is available regarding the acute effects of milrinone on platelets. Therefore, we evaluated the effects of milrinone on platelet number and function in cardiac surgical patients. Twenty-seven patients were studied during cardiac surgery requiring cardiopulmon...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199507000-00009
更新日期:1995-07-01 00:00:00
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:BACKGROUND:In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003315
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Pulmonary hypertension and resulting right ventricular (RV) dysfunction are associated with significant perioperative morbidity and mortality. Although echocardiography permits real-time, noninvasive assessment of RV function, objective and comparative measures are underdeveloped, and appropriate animal mode...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001215
更新日期:2016-05-01 00:00:00
abstract:UNLABELLED:The dose-response curve for the effect of volatile anesthetics on the somatosensory evoked potential (SEP) is well described, but for propofol, the large dose segment of the curve is undefined. We describe the effect of increasing plasma concentrations of propofol on cortical SEPs in 18 rats. After surgical ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000090318.16879.a8
更新日期:2003-12-01 00:00:00
abstract:BACKGROUND:Both propofol infusions with oxygen delivered through nasal cannula and isoflurane/N2O (nitrous oxide) delivered via a laryngeal mask airway (LMA) are used to provide anesthesia for children undergoing magnetic resonance imaging scans. We compared the incidence of adverse events and perioperative physiologic...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000000504
更新日期:2015-01-01 00:00:00
abstract:UNLABELLED:Previous reports indicate that cyclosporine increases sleeping time from barbiturate administration, and analgesia from fentanyl administration, suggesting a possible contribution of cyclosporine to anesthesia. Accordingly, we determined whether cyclosporine pretreatment decreases isoflurane MAC (the minimum...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200210000-00025
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Functional blockade of peripheral nerves is the primary objective of local anesthesia, and it is often desirable to have a persistent blockade, sustained throughout and beyond a surgical procedure. Current local anesthetics give effective analgesia for <8-12 h after a single bolus injection. We report on an ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318193596a
更新日期:2009-03-01 00:00:00
abstract:UNLABELLED:Flurbiprofen, a nonsteroidal antiinflammatory drug (NSAID), has been used to treat rheumatic and osteoarthritic pain and to reduce postoperative pain. Although other NSAIDs, such as indomethacin, reduce cerebral blood flow (CBF), the effect of flurbiprofen on CBF is unknown. In the present study, we investig...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000099755.97885.3c
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:As the use of pulse oximeters increases, the needs for higher performance and wider applicability of pulse oximetry have increased. To realize the full potential of pulse oximetry, it is indispensable to increase the number of optical wavelengths. To develop a multiwavelength oximetry system, a physical theo...
journal_title:Anesthesia and analgesia
pub_type: 历史文章,杂志文章
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更新日期:2007-12-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/ANE.0000000000000390
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Improved pain control after cesarean delivery remains a challenging objective. Poorly treated acute pain following delivery is associated with an increased risk of chronic pain and depression. This study was conducted to determine whether the addition of systemic acetaminophen and an increased dose of intrat...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000000695
更新日期:2016-04-01 00:00:00
abstract::A previous demonstration that the ratio of analgesic to anesthetic endpoints is not constant across inhalation anesthetic agents implies that more than one mechanism of action may be operant in general anesthesia. We hypothesized that the endogenous opiate systems might account for this observed disparity in ratios. T...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-04-01 00:00:00
abstract:UNLABELLED:Nonsteroidal antiinflammatory drugs (NSAIDs) provide effective postoperative analgesia after arthroscopic knee surgery. Some investigators have suggested that the preemptive administration of NSAIDs may reduce postoperative analgesic requirements and hypersensitivity. We evaluated the analgesic effect of adm...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200201000-00010
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Computerized reviews of patient data promise to improve patient care through early and accurate identification of at-risk and well patients. The significance of sampling strategy for patient vital signs data is not known. In the instance of the surgical Apgar score (SAS), we hypothesized that larger sampling...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182a46d6d
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002499
更新日期:2017-11-01 00:00:00
abstract::In order to evaluate the possible physiologic significance of intra- and postoperative hypotension, we monitored arterial blood pressure and heart rate continuously for 36 hr starting the night before and ending the morning after operation in 34 gynecologic patients. The lowest pressures that occurred during physiolog...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1984-07-01 00:00:00
abstract::The safety and utility of pediatric epidural analgesia is well established, but the risk of permanent neurological injury is unknown and largely must be extrapolated from adult literature. In this article we present a series of 4 cases of longterm or permanent neurologic complications associated with epidural analgesi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31826918b6
更新日期:2012-12-01 00:00:00
abstract:UNLABELLED:The optimal dose and timing of 5-HT(3) antagonist administration for prophylaxis against postoperative nausea and vomiting (PONV) remains controversial. Although 5-HT(3) antagonists seem to be most effective when administered near the end of surgery, there are no data on the comparative efficacy or costs ass...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200006000-00017
更新日期:2000-06-01 00:00:00
abstract:BACKGROUND:We compared temperature changes in patients undergoing hip replacement during warming with a resistive heating blanket or air-forced system. METHODS:Fifty-six patients were enrolled. Patients were randomly allocated to the "forced-air group" (forced-air system) or to the "heating-blanket group" (resistive h...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31818e6199
更新日期:2009-01-01 00:00:00