The efficacy of the psoas compartment block versus the intrathecal combination of morphine, fentanyl and bupivacaine for postoperative analgesia after primary hip arthroplasty: a randomized single-blinded study.

PURPOSE: Intrathecal morphine and psoas compartment block represent two accepted techniques to provide postoperative analgesia after hip arthroplasty. We designed a prospective, randomized, single-blinded study to compare these two techniques. METHODS: Forty patients scheduled for primary hip arthroplasty under general anesthesia were randomized to receive either an intrathecal administration of 0.1 mg morphine, 0.015 mg fentanyl and 15 mg hyperbaric bupivacaine (Group I, n = 20) or a psoas compartment block with ropivacaine 0.475% 25 mL (Group II, n = 20). Pain scores, morphine consumption, associated side-effects were assessed for 48 hr postoperatively. In addition, patient's satisfaction and acceptance of the postoperative analgesic technique were also recorded. RESULTS: During the first 24 hr, pain scores (12 +/- 27 vs 24 +/- 25 at H + 12, 12 +/- 46 vs 20 +/- 26 mm at H + 24, 16 +/- 19 vs 20 +/- 29 mm at H + 36) and tramadol consumption (30 +/- 70 vs 210 +/- 400 mg at H + 12, 180 +/- 120 vs 320 +/- 100 mg at H + 24) were slightly lower in Group I than in Group II, but there were no statistically significant differences. Itching was the most frequent side-effect occurring in 45% of cases in Group I vs 10% in Group II (P < 0.05). No major complication occurred. There was no difference in satisfaction scores between the two groups. CONCLUSION: Intrathecal administration of a combination of morphine, fentanyl and bupivacaine and single-shot psoas compartment block both provide very good postoperative analgesia after primary hip arthroplasty.

Auditory cortex involvement in emotional learning and memory.

Emotional memories represent the core of human and animal life and drive future choices and behaviors. Early research involving brain lesion studies in animals lead to the idea that the auditory cortex participates in emotional learning by processing the sensory features of auditory stimuli paired with emotional consequences and by transmitting this information to the amygdala. Nevertheless, electrophysiological and imaging studies revealed that, following emotional experiences, the auditory cortex undergoes learning-induced changes that are highly specific, associative and long lasting. These studies suggested that the role played by the auditory cortex goes beyond stimulus elaboration and transmission. Here, we discuss three major perspectives created by these data. In particular, we analyze the possible roles of the auditory cortex in emotional learning, we examine the recruitment of the auditory cortex during early and late memory trace encoding, and finally we consider the functional interplay between the auditory cortex and subcortical nuclei, such as the amygdala, that process affective information. We conclude that, starting from the early phase of memory encoding, the auditory cortex has a more prominent role in emotional learning, through its connections with subcortical nuclei, than is typically acknowledged.

[Anesthesia for neurosurgery in children: techniques and monitoring]. / Anestesia in neurochirurgia pediatrica: tecniche e monitoraggio.

Pediatric neuroanesthesia can be seen as a specific branch of anesthesia half way in between pediatric anesthesia and neuroanesthesia. As a matter of fact, we must keep well in mind the peculiarities of the pediatric patient and the different pharmadynamic and pharmacochinetic properties of the anesthetic drugs, particularly in neonates and infants. Other relevant problems are: 1) high complexity of surgical procedures implying a difficult anesthesiological management; 2) complex blood loss management either if we want to apply a blood sparing technique strategy or if we consider the problems related to diagnosis and treatment of coagulative disorders caused by intraoperative massive blood loss; 3) management of patients with latex allergy for the high incidence, in pediatric neuroanesthesia, of patients belonging to high risk groups; 4) need of repeated radiological examinations implying several anesthesiological procedures. In this article aspects related to the anesthesiological techniques and to the hemodynamic and neurophysiological monitoring of pediatric neurosurgical patients were also discussed.