scholarly journals Clinical Comparison of 12 mg Ropivacaine and 8 mg Bupivacaine, Both with 20 µg Fentanyl, in Spinal Anaesthesia for Major Orthopaedic Surgery in Geriatric Patients

2010 ◽  
Vol 19 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Engin Erturk ◽  
Cigdem Tutuncu ◽  
Ahmet Eroglu ◽  
Merih Gokben
Keyword(s):  
Spinal Anaesthesia ◽  
Orthopaedic Surgery ◽  
Geriatric Patients ◽  
Clinical Comparison ◽  
Major Orthopaedic Surgery

COMPARATIVE STUDY OF SEQUENTIAL COMBINED SPINAL EPIDURAL ANAESTHESIA VERSUS SPINAL ANAESTHESIA IN HIGH RISK GERIATRIC PATIENTS FOR MAJOR ORTHOPAEDIC SURGERY

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Sheetal .
Keyword(s):  
High Risk ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Geriatric Patients ◽  
Hyperbaric Bupivacaine ◽  
Combined Spinal Epidural ◽  
Group A ◽  
Major Orthopaedic Surgery ◽  
Group B ◽  
Spinal Epidural

Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block in this decade for high risk geriatric patients because here the advantages of both spinal and epidural anaesthesia are summated avoiding the side effects. This study is designed to compare the clinical effects of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients undergoing major orthopaedic procedure. Sixty patients aged 65 to 80 years, ASA III were randomly allocated into two equal groups. Group A (n=30)  received sequential combined spinal epidural anaesthesia with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 20  mg  fentanyl  through  spinal  route, and the expected incompleteness of spinal block was managed with small incremental dose  of  0.5%  isobaric bupivacaine  through epidural catheter, 1.5 to 2 ml for every unblocked segment to achieve T10 sensory level. Group B (n=30) received spinal anaesthesia with 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 20 mg of fentanyl. Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (p< 0.01) along with the provision of prolonging analgesia as compared to group B. So sequential combined spinal epidural anaesthesia is a safe, effective, reliable technique with stable haemodynamic along with provision of prolonging analgesia compared to spinal anaesthesia for high risk geriatric patients undergoing major orthopaedic surgery. Keywords: Sequential combined spinal epidural anaesthesia, Spinal anaesthesia, Fentanyl, Geriatric

scholarly journals Spinal anaesthesia: a comparison of plain ropivacaine 5 mg ml −1 with bupivacaine 5 mg ml −1 for major orthopaedic surgery

2003 ◽  
Vol 91 (1) ◽  
pp. 155-157
Author(s):  
T.M. Cook ◽  
D.A. McNamee ◽  
K.R. Milligan ◽  
L Westman ◽  
U Gustaffson
Keyword(s):  
Spinal Anaesthesia ◽  
Orthopaedic Surgery ◽  
Major Orthopaedic Surgery

scholarly journals Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml-1 with bupivacaine 5 mg ml-1 for major orthopaedic surgery

2002 ◽  
Vol 89 (5) ◽  
pp. 702-706 ◽  
Author(s):  
D. A. McNamee ◽  
A. M. McClelland ◽  
S. Scott ◽  
K. R. Milligan ◽  
L. Westman ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Orthopaedic Surgery ◽  
Major Orthopaedic Surgery

Post Discharge Clinically Overt Venous Thromboembolism in Orthopaedic Surgery Patients with Negative Venography -an Overview Analysis

1996 ◽  
Vol 76 (06) ◽  
pp. 0887-0892 ◽  
Author(s):  
Serena Ricotta ◽  
Alfonso lorio ◽  
Pasquale Parise ◽  
Giuseppe G Nenci ◽  
Giancarlo Agnelli
Keyword(s):  
Venous Thromboembolism ◽  
Orthopaedic Surgery ◽  
Diagnostic Methods ◽  
Future Research ◽  
Post Discharge ◽  
Pharmacological Prophylaxis ◽  
Vein Thrombosis ◽  
Overview Analysis ◽  
Major Orthopaedic Surgery

SummaryA high incidence of post-discharge venous thromboembolism in orthopaedic surgery patients has been recently reported drawing further attention to the unresolved issue of the optimal duration of the pharmacological prophylaxis. We performed an overview analysis in order to evaluate the incidence of late occurring clinically overt venous thromboembolism in major orthopaedic surgery patients discharged from the hospital with a negative venography and without further pharmacological prophylaxis. We selected the studies published from January 1974 to December 1995 on the prophylaxis of venous thromboembolism after major orthopaedic surgery fulfilling the following criteria: 1) adoption of pharmacological prophylaxis, 2) performing of a bilateral venography before discharge, 3) interruption of pharmacological prophylaxis at discharge in patients with negative venography, and 4) post-discharge follow-up of the patients for at least four weeks. Out of 31 identified studies, 13 fulfilled the overview criteria. The total number of evaluated patients was 4120. An adequate venography was obtained in 3469 patients (84.1%). In the 2361 patients with negative venography (68.1%), 30 episodes of symptomatic venous thromboembolism after hospital discharge were reported with a resulting cumulative incidence of 1.27% (95% C.I. 0.82-1.72) and a weighted mean incidence of 1.52% (95% C.I. 1.05-1.95). Six cases of pulmonary embolism were reported. Our overview showed a low incidence of clinically overt venous thromboembolism at follow-up in major orthopaedic surgery patients discharged with negative venography. Extending pharmacological prophylaxis in these patients does not appear to be justified. Venous thrombi leading to hospital re-admission are likely to be present but asymptomatic at the time of discharge. Future research should be directed toward improving the accuracy of non invasive diagnostic methods in order to replace venography in the screening of asymptomatic post-operative deep vein thrombosis.

Decisional capacity to consent to treatment and anaesthesia in patients over the age of 60 undergoing major orthopaedic surgery

2019 ◽  
Vol 59 (4) ◽  
pp. 247-254 ◽  
Author(s):  
Gabriele Mandarelli ◽  
Giovanna Parmigiani ◽  
Felice Carabellese ◽  
Silvia Codella ◽  
Paolo Roma ◽  
...  
Keyword(s):  
Informed Consent ◽  
Orthopaedic Surgery ◽  
Decisional Capacity ◽  
Capacity To Consent ◽  
Capacity Evaluation ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
Major Orthopaedic Surgery ◽  
Pain Symptoms ◽  
State Examination

Despite growing attention to the ability of patients to provide informed consent to treatment in different medical settings, few studies have dealt with the issue of informed consent to major orthopaedic surgery in those over the age of 60. This population is at risk of impaired decision-making capacity (DMC) because older age is often associated with a decline in cognitive function, and they often present with anxiety and depressive symptoms, which could also affect their capacity to consent to treatment. Consent to major orthopaedic surgery requires the patient to understand, retain and reason about complex procedures. This study was undertaken to extend the literature on decisional capacity to consent to surgery and anaesthesia of patients over the age of 60 undergoing major orthopaedic surgery. Recruited patients ( N=83) were evaluated using the Aid to Capacity Evaluation, the Beck Depression Inventory, the State–Trait Anxiety Inventory Y, the Mini-Mental State Examination and a visual analogue scale for measuring pain symptomatology. Impairment of medical DMC was common in the overall sample, with about 50% of the recruited patients showing a doubtful ability, or overt inability, to provide informed consent. Poor cognitive functioning was associated with reduced medical DMC, although no association was found between decisional capacity and depressive, anxiety and pain symptoms. These findings underline the need of an in-depth assessment of capacity in older patients undergoing major orthopaedic surgery.

Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery: A dose-finding study

Acute Pain ◽  
1998 ◽  
Vol 1 (2) ◽  
pp. 13-19 ◽  
Author(s):  
Terry Muldoon ◽  
Paul McConaghy ◽  
Alexander R Binning ◽  
Charles B Wallis ◽  
J Dennis R Connolly ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Orthopaedic Surgery ◽  
Epidural Infusion ◽  
Dose Finding ◽  
Continuous Epidural Infusion ◽  
Finding Study ◽  
Dose Finding Study ◽  
Major Orthopaedic Surgery

Major orthopaedic surgery and post-discharge DVT

The Lancet ◽  
1996 ◽  
Vol 348 (9022) ◽  
pp. 209-210 ◽  
Author(s):  
Jan W ten Cate ◽  
Martin H Prins
Keyword(s):  
Orthopaedic Surgery ◽  
Post Discharge ◽  
Major Orthopaedic Surgery

scholarly journals The measurement of cardiac troponins in patients undergoing major orthopaedic surgery

2010 ◽  
Vol 35 (3) ◽  
pp. 463-464 ◽  
Author(s):  
Giuseppe Lippi ◽  
Gianfranco Cervellin ◽  
Mario Plebani
Keyword(s):  
Orthopaedic Surgery ◽  
Major Orthopaedic Surgery ◽  
Cardiac Troponins

scholarly journals Postoperative analgesia in major orthopaedic surgery.

Anaesthesia ◽  
1981 ◽  
Vol 36 (10) ◽  
pp. 937-941 ◽  
Author(s):  
DAVID W. BARRON ◽  
JOHN E. STRONG
Keyword(s):  
Postoperative Analgesia ◽  
Orthopaedic Surgery ◽  
Major Orthopaedic Surgery
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