Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml.

BACKGROUND: Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double-blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine. METHODS: Patients undergoing inguinal hernia, appendectomy, varicose vein or minor orthopaedic operations were included in the study (60 patients; 47 male, 13 female, overall mean age 30 years). All patients had an American Society of Anesthesiologists score of I or II. The patients were randomly assigned to receive spinal anaesthesia with either 20 mg isobaric levobupivacaine (5 mg/ml) or 80 mg isobaric lidocaine (20 mg/ml). Onset of sensory and motor block and side effects were recorded. On post-operative days 1, 2, and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic used. The patients were classified as having TNS if, following recovery from anaesthesia, there was pain in the buttocks, thighs and/or lower limbs. RESULTS: In the levobupivacaine group, one patient (3.33%) experienced TNS, whereas in the lidocaine group, eight (26.6%) experienced TNS (P=0.002). Maximum times to arrival of sensory blocks were shorter with lidocaine (P<0.001). The levobupivacaine and lidocaine groups did not differ significantly in terms of the highest dermatome included in sensory block or motor block grade. CONCLUSION: After spinal anaesthesia with levobupivacaine, the incidence of TNS was much less than after lidocaine. However, it appears that TNS may occur in association with levobupivacaine.

Effect of locally administered lornoxicam in the management of low back pain after lumbar epidural anesthesia: a double-blind, randomized, controlled study.

AIM: Low back pain after lumbar epidural anesthesia remains an important clinical problem. Possible causes of the back pain associated with epidural anaesthesia are localized trauma, aseptic periosteitis, tendonitis, inflammation of the ligaments, and osteochondritis. Lornoxicam is a new nonsteroidal anti-inflammatory drug (NSAID) that has been shown to be effective and well tolerated in the treatment of postoperative pain. The use of locally administered lornoxicam for the relief of low back pain following lumbar epidural anesthesia has not yet been studied. Thus, the aim of the present study was to investigate the efficacy of lornoxicam in the management of pain after lumbar epidural anesthesia. METHODS: A total of 60 patients were randomized to receive either treatment with lornoxicam or to receive a control treatment. The Lornoxicam group received 12 ml of 0.5% epidural bupivacaine and 4 ml 1% lidocaine, along with 2 mg lornoxicam for local infiltration. The control group received 12 ml of 0.5% epidural and 4 mL 1% lidocaine alone for local infiltration. Following the initial preoperative evaluation, a blinded investigator assessed pain intensity at 24, 48 and 72 hours postoperatively using a Verbal Rating Scale (VRS). RESULTS: The overall frequency of low back pain after epidural anesthesia was significantly higher in control-group patients compared to Lornoxicam-group patients during the 3 days studied (26.6% and 6.6%, respectively, P<0.05). CONCLUSIONS: Our study demonstrated that local administration of Lornoxicam before epidural anesthesia for pilonidal sinus surgery decreased the frequency and severity of low back pain following lumbar epidural anesthesia with lidocaine. In conclusion, local administration of lornoxicam during epidural anesthesia may present a useful option for the relief of post-epidural low back pain.

Patient comfort and surgeon satisfaction during cataract surgery using topical anesthesia with or without dexmedetomidine sedation.

PURPOSE: To determine the safety and efficacy of perioperative dexmedetomidine (Dex) sedation on patient comfort and surgeon satisfaction during cataract surgery under topical anesthesia. METHODS: Forty-four patients having routine clear corneal phacoemulsification surgery under topical anesthesia were included in the study. Patients were randomly divided into two groups: Dex group (n=22) and control group (n=22). Patients in the Dex group were to receive intravenous Dex using an infusion pump and those in the control group were to receive 0.9% saline infusion. Primary outcome measures were patient comfort, surgeon satisfaction, and patient pain perception. RESULTS: There was no significant difference between the groups in terms of baseline characteristics including age, sex, eye side, pupil diameter, and vital signs (p>0.05 for all). Patient comfort and surgeon satisfaction in Dex group was better than in control group (p=0.042 and p=0.003, respectively). The mean pain perception score was lesser in the Dex group (1.23+-.72) than control group (3.64+/-1.43), (p<0.001). The mean surgical time and intraoperative complications were similar in both groups (p>0.05). There was no significant effect of the Dex sedation on vital signs perioperatively (p>0.05 for all). CONCLUSIONS: Dex sedation improved patient and surgeon satisfaction and decreased patients' pain perception while undergoing cataract surgery under topical anesthesia. It appears to be a safe and suitable choice of sedation for cataract surgery.

Tramadol does not prolong the effect of ropivacaine 7.5 mg/ml for axillary brachial plexus block.

BACKGROUND: The aim of this prospective, randomized, double-blind study was to evaluate the effect of the addition of tramadol to ropivacaine on the onset and duration of sensory and motor block, and duration of analgesia, for axillary brachial plexus block. METHODS: After institutional approval and informed consent had been obtained, 45 patients scheduled for forearm or hand surgery under axillary brachial plexus block were randomly allocated into two groups. The ropivacaine group received 40 ml of ropivacaine 7.5 mg/ml plus 2 ml of isotonic sodium chloride solution, and the tramadol group received 40 ml of ropivacaine 7.5 mg/ml plus 2 ml (100 mg) of tramadol. The onset and duration of sensory and motor block in the distribution of the musculocutaneous, radial, median and ulnar nerves, the duration of analgesia, the time to first pain medication, hemodynamics and side-effects were recorded. RESULTS: The addition of tramadol did not improve the speed of onset or increase the duration of sensory and motor block. The durations of analgesia were 631 +/- 33 min and 633 +/- 37 min (mean +/- standard deviation) in the ropivacaine and tramadol groups, respectively (P > 0.05). Hemodynamic parameters and side-effects did not differ between the groups. CONCLUSION: The addition of 100 mg of tramadol to 7.5 mg/ml of ropivacaine, for axillary brachial plexus block, does not prolong the duration of motor and sensory block and analgesia.