Marina Temelkovska-Stevanovska, Vesna Durnev, Marija Jovanovski-Srceva, Maja Mojsova-Mijovska and Sime Trpeski
1. Parker M, Johansen, A. Hip fracture. British Medical Journal. 2006; 333: 7557, 27–30.
2. Bottle A, Aylin, P. Mortality associated with delay in operation after hip fracture: observational study. British Medical Journal. 2006; 332: 947–951.
3. Bruckenthal P, D'Arcy Y. Assessment and manage ment of pain in older adults: A review of the basics. Topics in Advanced Practice Nursing eJournal. 2007; 7: 1.
4. Myles PS, Power I. Clinical update: postoperativeanalgesia. The Lancet. 2007; 369, 810–812.
5. Grant CRK, Chetketts MR. Analgesia for
Lazar Alexandra, Szederjesi Janos, Copotoiu Sanda Maria, Simon Noemi Szidonia, Badea Iudita and Azamfirei Leonard
scleroderma. Reg Anesth Pain Med, 2003; 28:354-358.
8. Vadivelu N, Gesquire M, Mitra S, et al. Safety of local anesthesia combined with monitored intravenous sedation for American Society of Anesthesiologists 3 and 4 patients undergoing lower limb-preservation procedures. Foot Ankle Surg, 2010;49:152-154.
9. Le-Wendling L, Enneking FK. Continuous peripheral nerve blockade for postoperativeanalgesia. Curr Opin Anaesthesiol, 2008;21:602-609.
10. Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiology Research and Practice, 2011
Iveta Golubovska, Pēteris Studers, Inta Jaunalksne and Indulis Vanags
Effects of Different Epidural Analgesic Compositions on Postoperative Pain Relief and Systemic Response to Surgery
Despite many achievements during the last decade, postoperative pain remains the dominant complaint after major surgery and has great potential to be influenced by the anaesthesiologist. Reports suggest that short-term effective anaesthesia and analgesia can have long-lasting beneficial effects on recovery from surgery. The aim of our study is to compare the effect of epidural analgesia, using different compositions, including glucocorticoids (methylprednisolone), and habitual composition of bupivacaine-morphine, in regard to analgesic and anti-inflammatory properties. A total of 129 patients participated in the study in four different treatment groups: patients from Group I received glucocorticoid methylprednisolone succinate and long-acting opioid morphine hydrochloride, Group II received local anaesthetic bupivacaine hydrochloride and morphine hydrochloride, Group III received methylprednisolone succinate and short-acting opioid fentanyl, and Group IV received glucocorticoid methylprednisolone succinate. We obtained good analgesic profiles in all groups. However, significantly better results were achieved using the combination of methylprednisolone and morphine. Epidural methylprednisolone in dose 80 mg/24 h is more effective, compared to the conventional local anaesthetics-opioid composition, when administered as a part of multimodal preventive postoperative analgesia after major joint replacement surgery. Epidural methylprednisolone has a reliable anti-inflammatory and immunomodulatory potential. It attenuates profiles of acute inflammatory response markers as Interleukin-6 and C-reactive protein and stress hormone cortisol. The novelty of this study was application of epidural glucocorticoids for acute postoperative pain relief as part of daily perioperative care. By developing studies on anti-inflammatory and immunomodulatory properties of glucocorticoids, we expect to improve patient rehabilitation in the postoperative period.
Witthaya Loetwiriyakul, Thanyamon Asampinwat, Panthila Rujirojindakul, Mayuree Vasinanukorn, Tee Chularojmontri, Rongrong Rueangchira-urai and Pannipa Phakam
, Takahashi T. Dosage of lidocaine for caudal anesthesia in infants and children. Anesthesiology. 1977; 47: 527-9.
17. Schrock CR, Jones MB. The dose of caudal epidural analgesia and duration of postoperativeanalgesia. Paediatr Anaesth. 2003; 13: 403 -8.
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19. Larousse E, Asehnoune K, Dartayet B, Albaladejo P, Dubousset AM, Gauthier F
Vanja Dzambazovska-Trajkovska, Jordan Nojkov, Andrijan Kartalov, Biljana Kuzmanovska, Tatjana Spiroska, Redzep Seljmani, Gjorgji Trajkovski, Nadica Matevska-Geshkovska and Aleksandar Dimovski
Background: The minimal effective analgesic concentration of opioids required for satisfactory analgesia may differ significantly among the patients. Genetic factors may contribute to the variable response to opioids by affecting their pharmacokinetics or pharmacodynamics.
Methods: Ninety nine patients undergoing abdominal surgery with colorectal anastomosis because of colorectal carcinoma were enrolled in the present study. C34535T was genotyped in all subjects and the patients were divided into three groups according to their genotype: CC-wild type homozygous, CT-mutant heterozygous and TT-mutant homozygous. Intravenous fentanyl, patient controlled analgesia was provided postoperatively for pain control in the first 24 hour after surgery. Opioid consumption, pain scores and the adverse side effects were evaluated.
Results: Our main result is that the patients in the CC genotype group consumed significantly more fentanyl (375.0 μg ± 43.1) than the patients in the TT group (295.0 μg ± 49.1) and the CT (356.4 μg ± 41.8) group in the treatment of postoperative pain. The patients in the TT group had lower VAS scores at 6h, 12h, 18 h and 24h postoperatively. There were no significant differences in the side effects among the three groups regarding the vomiting and the sedation score. The patients in the TT group had more frequently nausea score 1, than the patients in the other two groups.
Conclusion: Our study indicates that the C3435T SNPs of the ABCB1 gene is associated with differences in the opioid sensitivity. The ABCB1 polymorphism may serve as an important genetic predictor to guide the acute pain therapy in postoperative patients.
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Marija Tolevska, Filip Naumovski, Marija Srceva, Aleksandra Panovska Petrusheva, Rexhep Selmani and Atanas Sivevski
Background: Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of morphine dose over 24-hours.
Results: There were statistically significant differences in VAS scores between the groups I and II at all postoperative time points - 2hr, 4 hr, 6 hr, 12 hr and 24 hr. (P < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in the group II (mean = 3.73 ± 1. 41) than the group I (mean = 8.76 ± 2.41). This difference was statistically significant (p = 0.00076).
Conclusion: The ultrasound guided rectus sheath block used for umbilical hernia repair could reduce postoperative pain scores and the amount of morphine consumption in 24 hours postoperative period.
M. Gherghinescu, C. Molnar, D. Popa, C. Russu and C. Copotoiu
1. Poelman M, Apers J, Van den Brand H et al. The INCH-Trial: a multicentre randomized controlled trial comparing the efficacy of conventional open surgery and laparoscopic surgery for incisional hernia repair. BMC Surgery 2013;13:18.
2. Kingsnorth A, Banerjea A, Bhargava A. Incisional hernia repair - laparoscopic or open surgery? Ann R Coll Surg Engl 2009;91:631-636.
3. O’Neill P, Duarte F, Ribeiro I et al. Ropivacaine Continuous Wound Infusion Versus Epidural Morphine for PostoperativeAnalgesia
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Tatjana Spirovska, Aleksandra Panovska Petrusheva, Marija Tolevska, Marija Srceva, Vesna Durnev, Gjorgji Jota, Redzep Selmani and Atanas Sivevski
1. Jankovic Z. Transversus abdominis plane block: The holy grail of anesthesia for (lower) abdominal surgery. Periodicum biologicum Vol. III, No 2; 2009: 203-208.
2. Bonnet F, Berger J, and Aveline C. Transversus abdominis plane block: what is its role in postoperativeanalgesia? British Journal of Anaesthesia. 2009; 103 (4): 468-70.
3. MC Donnell JG, Curlry G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. The analgesic efficacy of transversus abdominis plane block after Caesarean delivery: A
Mircea Gherghinescu, Călin Molnar, Daniel Popa, Cristian Russu, Alexandra Lazăr and Constantin Copotoiu
Background: Hepatitis C prevalence in Romania is 3.5%. Nowadays, the treatment of this condition comprise of interferon. One of the interferon’s side effects is the reduction of collagen synthesis, substance that is necessary in the process of abdominal wall healing.
Case report: We report the case of a 56 years old female patient, admitted in our Clinic for a giant, recurrent incisional hernia. The patient’s history was eventful: a hysterectomy for uterine fibroma in 2009, incisional hernia repair in 2010, the treatment with Interferon in 2011 and 2012 for viral hepatitis C. A well represented subcutaneous tissue is observed intraoperator, a wall defect of 15 cm in diameter with a 5 mm thick muscle aponeurosis lay. We performed abdominal wall plasty by components separation technique, reinforced with a polypropylene mesh disposed on lay. Postoperative analgesia was provided by inserting a wound catheter through which Ropivacaine 0,5% was continuously injected for 72 hours. The postoperative evolution was uneventful, the patient being discharged 7 days after the surgical intervention.
Conclusions: The treatment with Interferon of hepatitis C can favor the recurrence of an incisional hernia. The Oscar Ramirez procedure seemed to be the best choice for surgical treatment of this giant incisional hernia. Postoperative analgesia can be accomplished by a wound catheter through which Ropivacaine 5% is continuously infiltrated.