Search

Background Intra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. Methods Patients with osteoarthritis were randomly allocated to two groups. Group I (n = 26) received 7 mL 0.5% lidocaine and group II (n = 26) received 7 mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30 minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. Results Demographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P = 0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P = 0.006, P = 0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P = 0.035, P = 0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P = 0.002, P Conclusions Intra-articular 0.5% lidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period.

This study evaluated the postoperative analgesic efficacies of fascia iliaca block and periarticular drug injection techniques after TKA (total knee arthroplasty) surgeries.Prospective, randomized clinical trial.University Teaching and Research Center.Seventy-one American Society of Anesthesiologists (ASA) I-III patients between 48 and 70 years of age who underwent total knee arthroplasty were randomized.Tenoxicam (20 mg) was administered intramuscularly to both groups of patients 30 minutes before surgery. Patients were randomized into two groups to receive fascia iliaca block before the induction of anesthesia (Group FI) or periarticular drug injection during the surgery (Group PI). All surgeries were performed under general anesthesia using standard techniques. Postoperative analgesia was provided with patient-controlled intravenous morphine.Total morphine consumption was the primary outcome measure and was recorded postoperatively at 1, 2, 6, 12 and 24 hours. Pain levels at rest and on movement (knee flexion) were evaluated using the Visual Analogue Scale (VAS) and recorded at the same time points. Patients' demographics, rescue analgesic demands, side effects, hemodynamics, and satisfaction scores were also recorded.The groups had similar VAS scores both at rest and on movement (P.05). However, the amount of cumulative morphine and use at each follow-up period was higher in Group PI (P.0001). The groups did not differ significantly in rescue analgesic use or side effects, such as nausea/vomiting, hemodynamic variables, and patient satisfaction scores (P.05).Fascia iliaca block may be used as an alternative method to periarticular injection, and it effectively reduces the amount of morphine used to relieve post-TKA pain.

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy. JUSTIFICATIVA E OBJETIVO: Comparamos a eficácia da administração de paracetamol versus dipirona em analgesia controlada pelo paciente (PCA) por via intravenosa (IV) para alívio da dor no período pós-operatório em crianças. MÉTODOS: O estudo foi composto por 120 crianças submetidas à tonsilectomia sob anestesia geral. Os pacientes foram divididos em três grupos de acordo com a dose IV de analgesia controlada pelo paciente no pós-operatório: paracetamol, dipirona ou placebo. A dor foi avaliada com uma escala visual analógica de 0-100 mm e escore de 1-4 para alívio da dor nos tempos de 30 minutos, uma, duas, quatro, seis, 12 e 24 horas de pós-operatório. Petidina (0,25 mg kg-1) foi administrada IV aos pacientes que precisaram de analgesia de resgate. A necessidade de petidina foi registrada durante as primeiras 24 horas de pós-operatório e os efeitos adversos relacionados ao tratamento foram registrados. RESULTADOS: Os escores da escala visual analógica no pós-operatório foram significativamente menores no grupo paracetamol em comparação com o grupo placebo em seis horas (p < 0,05) e no grupo dipirona em comparação com o grupo placebo em 30 minutos e seis horas (p < 0,05). Não houve diferença significativa em relação aos valores da escala visual analógica nos tempos avaliados de uma, duas, quatro, 12 e 24 horas. Não houve diferença significativa entre os grupos quanto ao escore de alívio da dor (p > 0,05). A necessidade de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação com o grupo placebo (62,5%, 68,4% vs. 90%, p < 0,05). Não houve diferença significativa entre os grupos em relação à incidência de náusea, vômito e outros efeitos adversos dos medicamentos (p > 0,05). CONCLUSÕES: Paracetamol e dipirona têm um perfil de boa tolerabilidade e propriedades analgésicas eficazes quando administrados IV para ACP no pós-operatório de crianças após tonsilectomia.

ResumoJustificativa e objetivoA sedação em paciente dependente de diálise com doença renal em estágio terminal (DRET) requer cautela como resultado da administração de altas doses de sedativos e suas complicações. Os regimes de sedação com múltiplas drogas podem ser superiores e vantajosos em relação ao consumo menor de drogas e aos eventos adversos que ocorrem facilmente em pacientes com DEET. Avaliamos os efeitos da pré‐medicação com dexmedetomidina sobre o consumo de propofol, os níveis de sedação com os escores da Observer's Assessment of Alertness and Sedation (OAA/S) e do índice bispectral (BIS), as alterações hemodinâmicas e os potenciais efeitos colaterais em pacientes geriátricos com DRET submetidos à cirurgia para fratura de quadril sob raquianestesia.MétodoNeste estudo randômico, controlado e duplo‐cego, 60 pacientes idosos (idade≥65 anos), com DRET e fratura de quadril, agendados para fixação intramedular de haste femoral anterógrada foram designados para grupos para receberam infusão intravenosa de solução salina (Grupo C) ou pré‐medicação com infusão de 0,5mg kg/10min de dexmedetomidina (DEX) (Grupo D). Todos os pacientes receberam infusão de propofol após a indução da raquianestesia.ResultadosO consumo total de propofol, a dose de propofol necessária para os níveis‐alvo de sedação de acordo com os escores da OAA/S, os valores do BIS e os tempos de recuperação foram significativamente menores no Grupo D (p

Patients with isolated peripheral branch neuralgia of trigeminal nerve usually receive traditional treatment such as medical therapy and interventional procedures targeting the entire trigeminal nerve or related ganglions. However, if the intractable pain is limited to a certain branch, the patient may also benefit from a peripheral and nerve-targeted interventional approach. Here, we report the management of a patient with isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with steroid and local anesthetic combination. 48years-old male patient diagnosed with trigeminal neuralgia was resistant to medical therapy for 3years. The pain site was isolated to the area of the right nasal wing, right lateral incisor, the upper right canine and the first premolar teeth. His pain was an electric shock-like, throbbing and stabbing with a pain score of 8-9 according to numeric rating scale (NRS) and 18 according to the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS). Following a diagnostic ultrasound-guided infraorbital nerve block with 1% lidocaine, the block was repeated twice with 15mg lidocaine and 1.5mg dexamethasone in a total volume of 1.5mL in a month. The patient's NRS and LANSS scores decreased to 2 and 8, for approximately 21months until this report was written. We suggest that ultrasound-guided infraorbital nerve block with dexamethasone and lidocaine combination may present as an initial interventional treatment option in patients with isolated infraorbital neuralgia.

Objective To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery. Design A prospective, randomized, single-center study. Setting A university hospital. Participants One hundred ninety-five patients scheduled for open-chest cardiac surgery. Interventions The study population consisted of patients for whom central vein catheterization was intended during cardiac surgery. Patients were randomized to 3 groups according to the route of central vein catheterization: the supraclavicular group: the supraclavicular approach for the subclavian vein (n = 65); the infraclavicular group: the infraclavicular approach for the subclavian vein (n = 65); and the jugular group: the internal jugular vein approach (n = 65). After the induction of anesthesia, central venous catheterization was performed according to the assigned approach. Measurements and Main Results The success rates for the assigned approach were 98%, 98%, and 92% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). The success rates in the first 3 attempts in patients who were catheterized successfully according to the assigned approach were 96%, 100%, and 96% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). There was no difference among groups in catheter insertion time (p > 0.05). After sternal retraction, central venous pressure trace loss and difficulty in fluid infusion were significantly more frequent in the infraclavicular group (21%) when compared with the supraclavicular (3%) and jugular groups (0%) (p = 0.01). There was no difference among groups in terms of catheter malposition, complications during catheterization, and rate of catheter-related infection. Conclusion The supraclavicular approach for subclavian vein catheterization is an acceptable alternative for central venous access during cardiac surgery in terms of procedural success rate, ease of placement, rate of complications, and usability after sternal retractor expansion.

Purpose: Family witnessed resuscitation is allowing family members to be present during cardiopulmonary resuscitation (CPR). This preliminary study aimed to examine the reactions of the family during CPR in south Turkey. Materials and methods: Twelve intensive care patients suffering from severe diseases were planned to be resuscitated nearby their family. CPR were ruled by a consultant physician while the relatives were prepared for the situation and accompanied by another consultant. The second consultant asked for the family for a witnessed CPR and gave details about CPR. Family members included parents, sisters, brothers, sons or daughters who were more than 18 years old. The family members’ reactions, emotional status, satisfactions were noted. Results: Death was expected in 4 patients while 8 patients were unexpected ones. One of the patients was 8 years old, two between 20 and 40, four between 40 and 60, five more than 60. Parents accompanied CPR for 3 patients (25%), sisters and brothers for 3 (25%) and sons and daughters for 6 patients (50%). Educational status revealed that 6 members were graduated from university (50%), while 4 from high (33.3%) and 2 from elementary schools (16.7%). Ten members (83.3%) standby the consultant and watched CPR with no excessive reaction. They were satisfied with the procedure and were sure that everything possible was done. The mother of 22 years old patient and sister of 38 years old patient excessively reacted the situation (16.7%). They were both living in the rural area. One was graduated from high school and the other from elementary school. Conclusion: If family members want to be with their loved ones when very closed to death, they should be allowed. It seems that emotional reactions depend on traditions, educations, genders and residential areas. All the family members should be supported during and after the experience.