Tramadol Added to Bupivacaine Does Not Prolong Analgesia of Continuous Psoas Compartment Block

The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups ( n  = 15). Visual analog scale pain score was not significantly different between the groups during the 48-hour follow-up period. Rescue analgesic consumption, nausea and vomiting, and the satisfaction scores were comparable between the groups ( P  > 0.05). Success with catheter placement adjacent to the lumbar plexus was 100%, and none of the patients developed any catheter-related complications. In conclusion, tramadol does not provide a clinically significant analgesic action as an adjunct to 0.25% bupivacaine for CPCB.     

Early non invasive detection of hypercarbia in two cardiac surgical patients

The availability of transcutaneous monitors has provided a means of non invasive assessment of CO₂ tension and a trend of the ventilation status commonly in infants and neonates. The authors describe two cases of hypercapnia diagnosed early in adults by the non invasive transcutaneous measurement of carbon dioxide (tcpCO₂) using TINA TCM4 in postoperative cardiac surgical patients who were mechanically ventilated. Curiously, this increase in tcpCO₂ levels was associated with a false increase in the tcpO₂ values though no changes in the ventilatory parameters to increase oxygenation were made. The probable mechanism of the increase in tcpO₂ levels with hypercarbia is discussed. Chakravarthy M, Narayan S, Govindarajan R, Rajeev S, Jawali V. Early non invasive detection of hypercarbia in two cardiac surgical patients.