A comparison of rocuronium and lidocaine for the prevention of postoperative myalgia after succinylcholine administration.

The incidence of postoperative myalgia (POM) after succinylcholine administration has been reported to range from 5% to 83%. The administration of small doses of nondepolarizing muscle relaxants or lidocaine before the administration of succinylcholine has been shown to decrease the incidence and severity of POM experienced by patients. The purpose of this investigation was to compare the severity of POM in subjects receiving pretreatment with rocuronium or lidocaine. Seventy-four subjects were enrolled in this randomized, double-blind investigation to measure the effect of pretreatment modalities on the incidence and severity of myalgia following succinylcholine administration. Pretreatment consisted of either lidocaine, 1.5 mg/kg, or rocuronium, 0.03 mg/kg. Myalgia was measured using a 4-point ordinal scale. Ordinal and nominal data were analyzed using a chi 2 test and the Fisher exact test. A P value of less than .05 was considered significant. Data for 53 subjects were included in the analysis. Of the lidocaine group, 21 (72%) of 29 reported no myalgia at 48 hours compared with only 9 (38%) of 24 in the rocuronium group (P = 0.023). Satisfaction was similar between the groups. Based on the results of this study, pretreatment with lidocaine may provide better relief from myalgia than rocuronium at 48 hours after surgery.

Assessment of postanesthesia short-term quality of life: a pilot study.

Quality of life is a major focus for researchers conducting studies on patient satisfaction and anesthetic outcomes. Efficacy and safety drive anesthesia providers' determination of the type of anesthesia administered, yet little consideration is given to postanesthesia quality of life from the patient's perspective. We hypothesized that patient-defined, postanesthesia short-term quality-of-life issues are significant factors to consider when selecting anesthesia. This study developed and piloted a tool to assess the impact of specific anesthetic techniques on postanesthesia short-term quality-of-life issues. In phase I, a panel of content experts developed a tool to measure postanesthesia short-term quality of life. In phase II, 50 same-day surgery subjects undergoing spinal or general anesthesia completed the tool on day 1 and on days 5, 6, or 7 postoperatively. The RAND 36-Item Health Survey was administered simultaneously to assess concurrent validity. Phase I resulted in a 40-item tool covering 3 domains. The Phase II pilot supported internal consistency and construct validity for the majority of tool items, although the tool did not correlate strongly with the RAND questionnaire. To confirm the dimensions used in the tool, we recommend a multicenter study permitting the application of factor analysis.

Use of a simple forearm tourniquet as an adjunct to an intravenous regional block.

Intravenous regional anesthesia (IVRA) is a well-recognized technique for producing anesthesia during surgical procedures of the extremities. It has been suggested that the application of a tourniquet to the forearm may improve the quality of the block. The purpose of this investigation was to determine whether the application of a forearm tourniquet would accelerate onset time and improve the density and quality of an intravenous regional block. Twenty volunteer subjects were enrolled and randomly assigned in this crossover investigation. Control subjects received a standard IVRA technique; experimental subjects received IVRA technique with the application of a simple forearm tourniquet. Pain was elicited by means of an electrical stimulus, and assessments were performed using a 100-mm Visual Analogue Scale (VAS). Paired t tests were used to examine differences between groups on the variables studied. It was noted that the arm with the tourniquet had a shorter time for the onset of anesthesia (P = .0008) and had lower 10-minute VAS tolerance (P = .0469). This investigation suggests that the application of a simple forearm tourniquet as an adjunct to IVRA provides a more rapid onset of anesthesia than when no tourniquet is applied and may improve the density and quality of the block.

The effect of spinal introducer needle use on postoperative back pain.

Postdural puncture back pain has a reported incidence ranging from 2% to 29% following the administration of a spinal anesthetic. The purpose of this investigation was to compare the back pain and patient satisfaction scores after the administration of a spinal anesthetic with or without the use of an 18-gauge introducer needle. Eighty-four men and women were randomly assigned to either control or experimental groups; 67 were included in data analysis. The control group (n = 33) received spinal anesthesia using only a spinal needle, while the experimental group (n = 34) received spinal anesthesia using an introducer needle to guide the placement of the spinal needle. Pain measurements were measured using a 100-mm Visual Analogue Scale upon arrival in the postanesthesia care unit, and at 24, 48, and 72 hours postoperatively. Patient satisfaction scores were evaluated using a 1 to 5 Lickert scale. No significant differences were found between groups concerning back pain or patient satisfaction scores upon discharge from the postanesthesia care unit, nor at 24, 48, and 72 hours postoperatively. However, a significant increase in the number of redirections between groups was observed in the nonintroducer group; despite this, back pain and patient satisfaction scores were not affected.