Does audiovisual stimulation with music and nature sights (MuViCure) reduce pain and discomfort during placement of a femoral nerve block?

MuViCure (Photobia ApS, Copenhagen, Denmark) is a new program for audiovisual stimulation. We hypothesized that audiovisual stimulation would reduce pain and discomfort and improve patients' well-being during placement of a femoral nerve block. Fifty-five outpatients scheduled for anterior cruciate ligament reconstruction were randomly allocated into three groups: the first group received audiovisual stimulation (MuViCure), the second group received audio stimulation (MusiCure, Gefion Records ApS, Virum, Denmark), and the third group received no intervention (control). Ten of the 55 patients underwent a qualitative in-depth interview 1-2 days after surgery. Pain and discomfort during the procedure were more prominent in the MuViCure group when compared with the other two groups. Despite these negative results, 14 of the 19 patients in the MuViCure group answered that MuViCure had a positive effect on their well-being. The qualitative interviews revealed that a number of factors other than the audiovisual stimulation had a significant impact on the patients' experience. The use of MuViCure may be more appropriate in other settings.

Thoracic paravertebral block for breast cancer surgery: a randomized double-blind study.

BACKGROUND: We examined in this randomized, double-blind study whether a multilevel paravertebral block performed before general anesthesia with propofol and a laryngeal mask enhances postoperative analgesia after breast cancer surgery. METHODS: Eighty-eight patients were randomized to receive paravertebral injections with either ropivacaine 0.5% (30 mL) or an equivalent amount of isotonic saline. Nine patients were excluded after randomization, thus 79 patients remained for evaluation (ropivacaine, n = 38; placebo, n = 41). Variables of efficacy were the amount of fentanyl delivered by the patient-controlled analgesia device in the postanesthesia care unit (PACU), postoperative pain measured on a numeric rating scale at regular intervals from the day of surgery and until the second postoperative day. RESULTS: The median consumption of fentanyl in the PACU was less in the ropivacaine group compared with the placebo group (0 microg [range: 0-250 microg] versus 100 microg [range: 0-800 microg], P = 0.001). Also, fewer patients in the ropivacaine group reported pain > or =3 on the numbers rating scale in the PACU (13 vs 31, P < 0.0001). No statistical difference in pain scores or consumption of analgesics could be demonstrated after discharge from the PACU. CONCLUSIONS: A multilevel paravertebral block provides good analgesia for breast surgery, but the duration of analgesia is briefer than described in previous studies.