Continuous Elastomeric Pump-Based Ropivacaine Wound Instillation after Open Abdominal Aortic Surgery: How Reliable Is the Technique?

2011 ◽  
Vol 14 (1) ◽  
pp. 51 ◽  
Author(s):  
Werner Baulig ◽  
Konrad Maurer ◽  
Oliver Michel Theusinger ◽  
Valentin Hinselmann ◽  
Barbara Baulig ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Aortic Surgery ◽  
Plasma Concentrations ◽  
Control Group ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic ◽  
Morphine Administration ◽  
Surgical Data ◽  
The Impact

Introduction: We aimed at quantifying the impact of continuous wound infusion with ropivacaine 0.33% on morphine administration and subjective pain relief in patients after open abdominal aortic repair in a double-blind, placebo-controlled study.Methods: Before closing the abdominal wound, 2 multihole ON-Q Soaker Catheters (I-Flow Corporation, Lake Forest, California, USA) were placed pre-peritoneally in opposite directions. Either ropivacaine 0.33% or saline 0.9% was delivered by an elastomeric pump at a rate of 2 mL/h for 72 hours in each of the catheters. Postoperative pain and morphine administration were assessed using the numerical rating scale (NRS) in 4-hour intervals. Total plasma concentrations of ropivacaine, unbound ropivacaine, and 1-acid glycoprotein (AAG) were measured daily. Mean arterial pressure, pulse rate, oxygen saturation, total amount of morphine administration, ventilation time, and length of stay in the intensive care unit (ICU) were recorded. At the end of the study period, the wound site and the condition of the catheters were assessed.Results: The study was terminated prematurely due to a malfunction of the elastomeric balloon pump resulting in toxic serum levels of total ropivacaine in 2 patients (11.4 mol/L and 10.0 mol/L, respectively) on the second postoperative day. Six patients had been allocated to the ropivacaine group, and 9 patients had been allocated to the control group. Demographic and surgical data were similar in both groups. During the first 3 postoperative days, no difference between the ropivacaine and the control group was found in NRS (P = .15, P = .46, and P = .88, respectively) and morphine administration (P = .48). Concentrations of unbound serum ropivacaine (0.11 0.08 mol/L) were below toxic level in all patients.Conclusion: Continuous wound infusion of ropivacaine 0.33% 2 mL/h using an elastomeric system was not reliable and did not improve postoperative pain control in patients after open abdominal aortic surgery.

scholarly journals Intravenous paracetamol vs. ketoprofen for pain management after the abdominal aortic surgery – pharmacokinetics and therapeutics

2016 ◽  
Vol 85 (4) ◽  
pp. 254-263
Author(s):  
Jowita Rosada-Kurasińska ◽  
Alicja Bartkowska-Śniatkowska ◽  
Agnieszka Bienert ◽  
Małgorzata Grześkowiak ◽  
Paweł Sobczyński ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Postoperative Pain ◽  
Aortic Surgery ◽  
Venous Pressure ◽  
Intensive Therapy ◽  
University Hospital ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic ◽  
Intravenous Paracetamol ◽  
The Mean

Introduction. Acute postoperative pain continues to be a dilemma to patients and clinicians.Aim. To define the efficacy, tolerability and pharmacokinetics of paracetamol and ketoprofen in patients after the abdominal aortic surgery. Setting and design in University hospital – intensive therapy unit (clinical part), clinical pharmacy and biopharmacy unit (biochemical part), and pharmaceutical company (statistical part). Prospective randomized study.Material and Methods. 40 adult patients (50–84 years) undergoing abdominal aortic surgery were randomized equally into two groups. After extubation the patients in group 1 (G1) were administered a 1 g paracetamol infusion, and in group 2 (G2) – a 100 mg ketoprofen infusion, both within 15 minutes. All the patients received an epidural infusion of bupivacaine with fentanyl. The following parameters were recorded: mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), plasma concentration of paracetamol and ketoprofen. Postoperative pain was assessed with the visual analogue scale (VAS).Results. The mean values of the MAP, HR and CVP were within normal limits in the both groups. No significant differences were noticed in the assessment of postoperative pain and total use of an opioid. The mean therapeutic plasma concentration of paracetamol and ketoprofen remained up to 180 minutes and up to 120 minutes, respecively.Conclusions. The study enabled us to conclude that intravenous paracetamol as well as ketoprofen have good effectiveness and tolerability. There is no need to modify dosage of these drugs to elderly patients. After paracetamol infusion the therapeutic plasma concentration remains longer than after the ketoprofen infusion.

Intravenous paracetamol vs. ketoprofen for pain management after the abdominal aortic surgery – pharmacokinetics and therapeutics

10.20883/176 ◽  
2016 ◽  
Vol 85 (4) ◽  
pp. 254
Author(s):  
Jowita Rosada-Kurasińska ◽  
Alicja Bartkowska-Śniatkowska ◽  
Agnieszka Bienert ◽  
Małgorzata Grześkowiak ◽  
Paweł Sobczyński ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Postoperative Pain ◽  
Aortic Surgery ◽  
Venous Pressure ◽  
Intensive Therapy ◽  
University Hospital ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic ◽  
Intravenous Paracetamol ◽  
The Mean

Introduction. Acute postoperative pain continues to be a dilemma to patients and clinicians.Aim. To define the efficacy, tolerability and pharmacokinetics of paracetamol and ketoprofen in patients after the abdominal aortic surgery. Setting and design in University hospital – intensive therapy unit (clinical part), clinical pharmacy and biopharmacy unit (biochemical part), and pharmaceutical company (statistical part). Prospective randomized study.Material and Methods. 40 adult patients (50–84 years) undergoing abdominal aortic surgery were randomized equally into two groups. After extubation the patients in group 1 (G1) were administered a 1 g paracetamol infusion, and in group 2 (G2) – a 100 mg ketoprofen infusion, both within 15 minutes. All the patients received an epidural infusion of bupivacaine with fentanyl. The following parameters were recorded: mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), plasma concentration of paracetamol and ketoprofen. Postoperative pain was assessed with the visual analogue scale (VAS).Results. The mean values of the MAP, HR and CVP were within normal limits in the both groups. No significant differences were noticed in the assessment of postoperative pain and total use of an opioid. The mean therapeutic plasma concentration of paracetamol and ketoprofen remained up to 180 minutes and up to 120 minutes, respecively.Conclusions. The study enabled us to conclude that intravenous paracetamol as well as ketoprofen have good effectiveness and tolerability. There is no need to modify dosage of these drugs to elderly patients. After paracetamol infusion the therapeutic plasma concentration remains longer than after the ketoprofen infusion.

scholarly journals The influence of cardiac output on propofol and fentanyl pharmacokinetics and pharmacodynamics in patients undergoing abdominal aortic surgery

2020 ◽  
Vol 47 (6) ◽  
pp. 583-596
Author(s):  
Agnieszka Bienert ◽  
Paweł Sobczyński ◽  
Katarzyna Młodawska ◽  
Roma Hartmann-Sobczyńska ◽  
Edmund Grześkowiak ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Bispectral Index ◽  
Aortic Surgery ◽  
Plasma Concentrations ◽  
Effect Compartment ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Mixed Effect ◽  
Abdominal Aortic Surgery ◽  
Age Related ◽  
Abdominal Aortic

Abstract Cardiac output (CO) is expected to affect elimination and distribution of highly extracted and perfusion rate-limited drugs. This work was undertaken to quantify the effect of CO measured by the pulse pressure method on pharmacokinetics and pharmacodynamics of propofol and fentanyl administrated during total intravenous anesthesia (TIVA). The data were obtained from 22 ASA III patients undergoing abdominal aortic surgery. Propofol was administered via target-controlled infusion system (Diprifusor) and fentanyl was administered at a dose of 2–3 µg/kg each time analgesia appeared to be inadequate. Hemodynamic measurements as well as bispectral index were monitored and recorded throughout the surgery. Data analysis was performed by using a non-linear mixed-effect population modeling (NONMEM 7.4 software). Three compartment models that incorporated blood flows as parameters were used to describe propofol and fentanyl pharmacokinetics. The delay of the anesthetic effect, with respect to plasma concentrations, was described using a biophase (effect) compartment. The bispectral index was linked to the propofol and fentanyl effect site concentrations through a synergistic Emax model. An empirical linear model was used to describe CO changes observed during the surgery. Cardiac output was identified as an important predictor of propofol and fentanyl pharmacokinetics. Consequently, it affected the depth of anesthesia and the recovery time after propofol-fentanyl TIVA infusion cessation. The model predicted (not observed) CO values correlated best with measured responses. Patients‘ age was identified as a covariate affecting the rate of CO changes during the anesthesia leading to age-related difference in individual patient’s responses to both drugs.

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

Analysis of the intervention effect and self-satisfaction of sports dance exercise on the psychological stress of college students

Work ◽  
2021 ◽  
pp. 1-13
Author(s):  
Changliang Zheng ◽  
Hongmei Ji
Keyword(s):  
College Students ◽  
Stress Response ◽  
Psychological Stress ◽  
Rating Scale ◽  
Response Characteristic ◽  
Control Group ◽  
Observation Group ◽  
Excessive Pressure ◽  
Psychological Pressure ◽  
The Impact

BACKGROUND: College students are a high-risk subpopulation of psychological disorders. The problem of various adverse phenomena and consequences caused by excessive pressure on college students has gradually become the focus of social and psychological academic circles. However, studies related to individual self-concept and psychological pressure are rare. OBJECTIVE: To explore the impact of sports dance exercises on college students’ psychological pressure and improve the psychological effects of their self-satisfaction. METHODS: College students were taken as research objects, randomly divided into a control group and an observation group. The observation group is intervened with sports dance exercises. The observation group was intervened with sports dance exercises. The stress response characteristic questionnaire and multidimensional self-satisfaction rating scale were utilized to measure college students’ conditions before and after the intervention. Finally, the obtained data were statistically analyzed. RESULTS: Generally, the psychological stress response of college students was mild, with self-satisfaction and various dimensions at a moderately higher level. No significant differences were discovered in the psychological stress response and self-satisfaction level between the control group and the observation group before intervention (P >  0.05), which were homogeneous. Compared with the data obtained before the intervention, after the intervention, the control group scores were slightly reduced in all dimensions of the psychological stress response and self-satisfaction. In contrast, the scores were significantly increased in the experimental group (P <  0.05). Psychological stress response could reliably explain 30.4%of the total self-satisfaction variance (P <  0.01). The negative self-evaluation was the most important variable affecting self-satisfaction, followed by poor interpersonal communication and poor sleeping quality. CONCLUSIONS: Sports dance exercises could alleviate the psychological stress of college students and improve their self-satisfaction. Colleges and universities should include sports dance in the content of optional public courses and encourage more college students to actively participate in sports dance exercises to improve their mental health.

Incidence and circumstances of serum creatinine increase after abdominal aortic surgery

2003 ◽  
Vol 29 (10) ◽  
pp. 1821-1824 ◽  
Author(s):  
Frédérique Ryckwaert ◽  
Pierre Alric ◽  
Marie-Christine Picot ◽  
Kela Djoufelkit ◽  
Pascal Colson
Keyword(s):  
Serum Creatinine ◽  
Aortic Surgery ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic
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