Levobupivacaine and ropivacaine in the infraclavicular brachial plexus block.

AIM: Infraclavicular brachial plexus block were first described by Raj, yet this block remained underutilized despite theoretical advantages. The aim of this prospective, randomized study was to compare equipotent doses of levobupivacaine and ropivacaine. METHODS: For this prospective, randomized study we have enrolled, after informed consent, 30 patients of both sexes, ASA status I-II, who were going to receive surgery to the forearm or hand with tourniquet position on the arm. The infraclavicular plexus block was performed by using vertical technique. The block was performed with 30 mL of levobupivacaine 0.5% or ropivacaine 0.75%. RESULTS: No differences were reported between 2 groups in terms of demographic data. The onset-time for motor block was greater for ropivacaine group (p<0.05); the sensitive block was longer in levobupivacaine group (p<0.05). CONCLUSIONS: The long duration of sensory block associated with the with good analgesia, less toxicity and the pharmacodynamic properties of levobupivacaine include this new local anaesthetic as a valid choice respect other local anaesthetic for infraclavicular plexus block.

Levobupivacaine versus ropivacaine in psoas compartment block and sciatic nerve block in orthopedic surgery of the lower extremity.

AIM: The aim of this study was to compare the clinical profiles of psoas block and sciatic nerve block performed with either 0.5% levobupivacaine or 0.75% ropivacaine. METHODS: With ethical committee approval and written informed consent 80 ASA physical status I-II patients, undergoing lower extremity surgery received intravenous premedication with midazolam (0.05 mg/kg) and atropine (0.01 mg/kg). Patients were randomly allocated to receive a lumbar plexus block with: Levobupivacaine Group (L) 30 ml of 0.5% levobupivacaine or Ropivacaine Group (R) 0.75% ropivacaine, and sciatic nerve block with: Group R 10 ml 0.75 ropivacaine or Group L 0.5% levobupivacaine. The onset time and duration of nerve block were evaluated. RESULTS: The motor onset time was shorter in Group L than in Group R. The motor offset time was similar in the 2 groups, the time being slightly greater for Group R. Group L presented a higher difference of resolution to motor-sensitive block compared to Group R. CONCLUSIONS: The differences between Groups L and R were characterised by: a faster motor onset time in Group L with a longer time between motor and sensitive resolution determining a lower demand for analgesic drugs postoperatively and greater support for motor control recovery.

[Anesthesia-analgesia with remifentanil. Instrumental, laboratory and clinical evaluations]. / Anestesia analgesica con remifentanil. Valutazioni clinico-laboratoristiche-strumentali.

The option of analgesic anaesthesia without hypnotic was investigated in 13 patients, submitted to general, orthopedic or urologic surgery. Induction and maintenance of anaesthesia was performed with syringe-pump infusion of remifentanil 1-->2.2 mcg/kg/m and cisatrecurium, 0.2/air with FIO2 0.3; ecg monitoring, sieric level of ACTH were studied. "Slipping 8 channels patterns" were observed without spindless and K complexes; only in 2 patients N2O 50% can be used for increasing the depth of narcosys; ACTH levels increases only after remifentanil infusion stop.

Thyroid and thymic endocrine function and survival in severely traumatized patients with or without head injury.

OBJECTIVE: Functional links among the brain, endocrine and immune system have been described previously. An impairment of both immunological defence mechanisms and thyroid hormone turnover was present in trauma conditions. An investigation on the relevance of thymulin and thyroid hormones in multiple trauma patients with or without head injury has been performed. The role of these hormones as predictive factors for patients outcome was also evaluated. DESIGN: Plasma thymulin levels and plasma thyroid hormone concentrations were tested in multiple trauma patients 24 h after admission to the Intensive Care Unit (ICU) and again after 5 and 10 days. SETTING: Department of Immunology Ctr. INRCA, IInd ICU, S. Matteo Hospital Pavia and ICU "Umberto I" Hospital, Ancona. PATIENTS: 45 patients were evaluated including 14 multiple trauma patients without head injury and 31 multiple trauma patients with head injury at various level of coma, graded according to the Glascow Coma Score (GCS). INTERVENTIONS: Routine protocol interventions were performed in all head injured patients. MEASUREMENTS AND RESULTS: Thymulin and triiodothyronine (T3) levels were reduced, and reverse triiodothyronine (rT3) increased in all traumatized patients, but multiple trauma patients with head injury and GCS < or = 5 had the lowest levels of thymulin and T3 and the highest levels of rT3. No difference in plasma thyroxine (T4) and thyrotropin (TSH) levels was observed among injured patients. The analysis of predictive factors for the outcome has assigned to thymulin the highest score (29.6%) compared with the score for T3 (19.3%) and rT3 (26.3%). The total relative risk (delta %) calculated on the basis of T3 or rT3 rises significantly when thymulin relative risk is added. CONCLUSIONS: Thymulin is markedly reduced in multiple trauma patients with head injury and it represents a predictive factor for the outcome better than the one deriving from the single measurements restricted to thyroid hormones.

Effects of carnitine administration to multiple injury patients receiving total parenteral nutrition.

Blood, urine and tissue concentrations of carnitine have been found to be below the normal values in patients receiving total parenteral nutrition (TPN). It might be postulated that the carnitine deficiency is responsible for the metabolic disturbances observed during TPN. To 20 patients (10 male and 10 female) in a state of coma following multiple injuries or brain injury and submitted to a TPN regimen (hypertonic polycarbohydrate, 7% aminoacid solutions on 10% lipid suspensions), we have administered 3-8 g/day of carnitine i.v. as a single bolus each morning. We have found no increase in cholesterol and triglycerides serum levels and a normalization of pyruvate and lactate serum levels. Our results seem to confirm the importance of carnitine in improving metabolism of the energy-giving substrate in patients receiving TPN.

Treatment of postoperative pain with suprofen injected by the intramuscular route.

The analgesic effect and the tolerability of alpha-methyl-4-(2-thienyl-carbonyl)phenylacetic acid (suprofen, Suprol) 200 mg/ml were compared with lysine acetylsalicylate 0.9 g/2.5 ml; the study included 60 subjects in severe to very severe pain following orthopedic surgery. The trial was performed in randomized single-blind fashion in patients who had given informed consent. The substances were injected into the upper out quadrant; maximally 4 intramuscular injections were given within 2 days. The test population was homogeneous with respect to the anamnestic data. The intensity of pain prior to treatment was comparable in both groups. Statistical analysis of the data revealed that suprofen was at the rating times (15 min to 4 h) significantly superior to the control groups. The investigator's and the patients' final appreciation indicated good to very good effect in 93% of the subjects on suprofen, and in 40 and 47%, respectively, of the patients in the control group. Here, too, suprofen was significantly superior to the reference Substance. Systemic and local tolerability of both drugs was very good. Adverse drug experience (heartburn) occurred in only 1 patient in the control group.

A combination of cefuroxime plus acetylcysteine in the intensive care of patients with respiratory insufficiency.

Thirty patients admitted to our Intensive Care Unit for respiratory insufficiency attributable to a variety of disease conditions were treated with a combination of cefuroxime plus acetylcysteine. Clinical and laboratory variables were evaluated, and bacteriological tests were performed on tracheal aspirate. At the end of treatment, 12 patients were judged to be recovered, 14 improved and 4 unchanged. No side effects were observed.

[Closed abdominal injuries: the diagnostic reliability of ultrasonics]. / Traumi addominali chiusi: affidabilità diagnostica degli ultrasuoni.

47 consecutive patients underwent a ultrasound examination: they had suspect clinical-laboratorial picture caused from traumatic lesions of the abdominal viscera. We considered two kinds of visceral lesions: alterations of the parenchimal organs and of the empty ones. In the first group we analyzed direct signs of the lesion; in the second group we considered the indirect signs (hemothorax, hemoperitoneum and so on). Sometimes meteorism and the patient's conditions limited the reliability of the examination. We registered three false negative in volumetrically regular spleens, the seat hampering the complete exploration of the organ; on the contrary the lack of experience may cause interpretative mistakes (false positive). The obtained results induce to consider the employment of the ultrasound diagnostic imaging in abdominal traumas as a first approach, efficient test because, very often, it can condition surgical decisions, avoiding more aggressive diagnostic investigations.

[New orientations in the treatment of proclaimed tetanus: use of continuous peridural anesthesia]. / Nuovi orientamenti nel trattamento del tetano conclamato: uso della peridurale continua

Notes on the typical infectious and toxis picture associated with tetatus and the physiopathological aspects of the disease are followed by the presentation of continuous C8-L2 peridural anaesthesia, giving antalgic relief and partial motor block, as a primary form of therapeutic management. A classic two catheter technique is employed and fractioned doses are used so as to exploit the action of the local anaesthetic absorbed by the patient over several days. Sedation of the orthosympathetic leads to reduced catecholamine production, hypometabolism and cardiac sedation. Analgesia and relaxation are achieved by blocking the local and general spasms typical of the disease. Success with the method in serious cases is mentioned and its use in all forms is recommended.