Infusão intraoperatória de esmolol reduz o consumo pós‐operatório de analgésicos e o uso de anestésico durante a septorrinoplastia: estudo randômico

Background and objectives

Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia.

Method

This randomized‐controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β‐blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group) and 30 patients received normal saline and remifentanil (control group) as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10 min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded.

Results

The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60 min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group.

Conclusions

Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia.     

Bloqueio do plano eretor da espinha guiado por ultrassom para analgesia pós‐operatória em mamoplastia de aumento: série de casos

Augmentation mammoplasty is the third most frequently performed esthetic surgical procedure worldwide. Breast augmentation with prosthetic implants requires the insertion of an implant under breast tissue, which causes severe pain due to tissue extension and surgical trauma to separated tissues. In this case series, we present the successful pain management of six patients with ultrasound‐guided Erector Spinae Plane block after augmentation mammoplasty. In the operating room, all patients received standard monitoring. While the patients were sitting, the anesthesiologist performed bilateral ultrasound‐guided erector spinae plane block at the level of T5. Bupivacaine (0.25%, 20 mL) was injected deep to the erector spinae muscle. Then, induction of anesthesia was performed with propofol, fentanyl, and rocuronium bromide. All patients received intravenous dexketoprofen trometamol for analgesia. The mean operation time was 72.5?±6 min and none of the patients received additional fentanyl. The mean pain scores of the patients were 1, 2, 2, and 2 at the postoperative 5 th, 30th, 60th and 120th minutes, respectively. At the postoperative 24th hour, the mean Numerical Rating Scale score was 1. The mean intravenous tramadol consumption was 70.8±15.3 mg in the first 24 h. None of the patients had any complications related to erector spinae plane block.     

Bloqueio do plano abdominal transverso guiado por ultrassom em pacientes submetidos à colecistectomia laparoscópica: comparação da eficácia de bupivacaína e levobupivacaína no controle da dor pós‐operatória

Background and objective

The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound‐guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy.

Bloqueio PECS I para analgesia pós‐operatória em pacientes submetidos a mamoplastia de aumento: estudo randomizado,duplo‐cego,controlado por placebo

Background and objectivesPECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population.MethodsThis was a randomized, double‐blind, placebo‐controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg^‐1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 − 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05).ResultsIn the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 − 5.56; mean 95% CI), 3.75 (3.13 − 4.37), 3.79 (2.93 − 4.64), and 2.29 (1.56 − 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 − 5.60), 4.00 (3.50 − 4.49), 3.93 (3.12 − 4.73), and 2.29 (1.56 − 3.01), respectively.ConclusionsPECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.     

Comparação entre dois dispositivos supraglóticos de vias aéreas na dor de garganta pós‐operatória em crianças: estudo controlado prospectivo randomizado

Background and objectiveSore throat is well recognized complaint after receiving general anesthesia. This study is conducted to compare the severity and frequency of postoperative sore throat in children undergoing elective surgery – following the use of Ambu laryngeal mask airway) or I‐gel® – who are able to self‐report postoperative sore throat.MethodSeventy children, 6 to 16 years‐old, undergoing elective surgery randomly allocated to either Ambu laryngeal mask (Ambu Group) or I‐gel® (I‐gel Group). After the procedure, patients were interviewed in the recovery room immediately, after one hour, 6 and 24 hours postoperatively by an independent observer blinded to the device used intra‐operatively.ResultsOn arrival in the recovery room 17.1% (n = 6) of children of the Ambu Group complained of postoperative sore throat, against 5.7% in I‐gel Group (n = 2). After one hour, the results were similar. After 6 hours, postoperative sore throat was found in 8.6% (n = 3) of the children in Ambu group vs. 2.9% (n = 1) in I‐gel Group. After 24 hours, 2.9% (n = 1) of the kids in Ambu Group compared to none in I‐gel Group. There was no significant difference found in the incidence of postoperative sore throat in both devices on arrival (p = 0.28); after 1 hour (p = 0.28); after 6 hours (p = 0.30); and after 24 hours (p = 0.31). The duration of the insertion was shorter in Ambu Group and it was easier to insert the I‐gel® (p = 0.029). Oropharyngeal seal pressure of I‐gel® was higher than that of Ambu laryngeal mask (p = 0.001).ConclusionThe severity and frequency of postoperative sore throat in children is not statistically significant in the I‐gel Group compared to Ambu Group.