Comparison of the effects of low volume prilocaine and alkalinized prilocaine for the regional intravenous anesthesia technique in hand and wrist surgery

Effects of a Modified Long-Acting Cocktail on Analgesia and Enhanced Recovery After Total Hip Arthroplasty: A Double-Blinded Randomized Clinical Trial

BACKGROUND

We compared the efficacy and safety of a modified cocktail for postoperative analgesia and early functional rehabilitation in patients undergoing total hip arthroplasty (THA).

METHODS

Magnesium sulfate and sodium bicarbonate were added to a cocktail of ropivacaine, epinephrine, and dexamethasone. Primary outcome measures were visual analog scale (VAS) pain scores at various intervals after surgery, morphine consumption for rescue analgesia after surgery, and time to first rescue analgesia. Secondary outcomes were hip function after surgery, daily walking distance, quadriceps muscle strength, and the incidence of postoperative adverse reactions.

RESULTS

Morphine consumption was significantly lower in the modified cocktail group than in the control group in the first 24 hours after surgery (6.2 ± 6.0 versus 14.2 ± 6.4 mg, P < .001), as was total morphine consumption (10.0 ± 8.6 versus 19.2 ± 10.1 mg, P < .001). The duration of the first rescue analgesia was significantly prolonged (23.7 ± 10.3 versus 11.9 ± 5.8 mg, P < .001). Morphine consumption was also reduced in the magnesium sulfate and sodium bicarbonate groups over a 24-hour period compared to the control group (P < .001). The modified cocktail group had significantly lower resting VAS pain scores than the control group within 24 hours after surgery (P < .050). The VAS pain scores during movement within 12 hours after surgery were also lower (P < .050). The experimental groups showed better hip range of motion (P < .050) and longer walking distance (P < .050) on the first postoperative day, and levels of inflammatory markers were significantly reduced. The incidence of postoperative adverse reactions was similar among the 4 groups.

CONCLUSIONS

The modified cocktail with a new adjuvant can prolong the duration of postoperative analgesia, reduce the dosage of rescue analgesics, and accelerate early postoperative functional recovery in patients undergoing THA.

Single sterile silicon ring technique for utilization of upper limb intravenous regional anesthesia: A prospective study of patients with operated distal radius fractures

INTRODUCTION

Intravenous regional anesthesia is a well-established method of anesthesia in upper extremity surgery. In this study, we present a modification of the technique using a silicon ring tourniquet in 30 patients undergoing internal fixation for distal radius fractures.

METHODS

A sterile silicone ring wrapped within a stockinette sleeve was applied, and a local anesthetic solution (3 mg/kg lidocaine 0,5%) was injected intravenously. After anesthesia onset, the ring was rolled distally to provide immediate pain and discomfort relief.

RESULTS

The silicone ring achieved adequate exsanguination in all patients. Mean pain VAS score was 2.7 ± 0.9 intraoperatively and 4.3 ± 1.3 during the first hour postoperatively. The onset and termination times of sensory block were 5.8 ± 2.1 and 102 ± 7.8 min, and of motor block 13.8 ± 2.8 and 54.2 ± 4.6 min, accordingly. All patients were satisfied from the procedure.

CONCLUSION

Sterile silicone ring tourniquet application is a simple, safe and effective analgesic and anesthetic technique for the operative treatment of distal radius fractures.