OBJECTIVETo investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia (PCEA) after pulmonary lobectomy.

METHODSForty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group (22 patients) or ropivacaine group (21 patients). In the tetracaine group, 0.15% tetracaine was used for postoperative PCEA, while 0.3% ropivacaine was used in the ropivacaine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visa analogue scale (VAS). Forced expired volume at the 1st second (FEV1.0), forced vital capacity (FVC), FEV1.0/FVC and peak expired flow (PEF) were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study.

RESULTSVAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation, pulmonary function was reduced in both groups. However, there were no significant differences between the percentage of the changes of FEV1.0, FEV1.0/FVC and PEF in the two groups. There were also significant differences between the percentage of the changes of heart rate, mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief.

CONCLUSIONSThe analgesic effect of 0.15% tetracaine is similar to that of 0.3% ropivacaine used in patient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.

Adolescent ; Adult ; Amides ; therapeutic use ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; methods ; Anesthetics, Local ; therapeutic use ; Humans ; Middle Aged ; Pain Measurement ; Pain, Postoperative ; drug therapy ; Pneumonectomy ; Tetracaine ; therapeutic use

OBJECTIVE: We wanted to assess the relationship between pain and the prostate volume during transrectal ultrasound (TRUS) guided biopsy. MATERIALS AND METHODS: Between July and September 2006, 71 patients scheduled for TRUS biopsy of the prostate were considered for inclusion to this study. These patients underwent periprostatic neurovascular bundle block with lidocaine prior to biopsy. Pain was assessed using a Visual Analogue Scale (VAS) during periprostatic neurovascular bundle block (VAS 1), during biopsy (VAS 2), and 20 minutes after biopsy (VAS 3). The mean pain scores were analyzed in the large prostate group (prostate volume > 40 cc) and the small prostate group (prostate volume < or = 40 cc). P values < 0.05 were considered significant. RESULTS: The mean prostate volume was 42.2 cc (standard deviation: 8.6). The mean pain scores of VAS 1, 2 and 3 were 4.70 +/- 1.61, 3.15 +/- 2.44 and 1.05 +/- 1.51, respectively. In the large prostate group, the mean pains scores of VAS 1, 2 and 3 were 4.75 +/- 1.76, 3.51 +/- 2.76 and 1.29 +/- 1.70, respectively, whereas in the small prostate group, the means pain scores were 4.66 +/- 1.46, 2.77 +/- 2.0, and 0.80 +/- 1.26, respectively. Although there were no statistical differences of VAS 1, the larger prostate group revealed higher pain scores of VAS 2 and 3 compared with the small prostate group (p < 0.05). CONCLUSION: Patients with larger prostate volumes tend to feel more pain during and after TRUS guided prostate biopsy. Our findings suggest that additional analgesic strategies may be necessary when the patients with larger prostate undergo TRUS guided prostate biopsy.
Aged ; Anesthetics, Local/therapeutic use ; *Biopsy, Fine-Needle ; Humans ; Lidocaine/therapeutic use ; Male ; Middle Aged ; Nerve Block ; *Pain Measurement ; Prospective Studies ; Prostate/*pathology ; Ultrasonography, Interventional

BACKGROUNDIntrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose (MLAD) of intrathecal ropivacaine for non-obstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacaine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio.

METHODSWe enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine. The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection.

RESULTSThe intrathecal MLAD was 9.45 mg (95%confidence interval (CI), 8.45 - 10.56 mg) for ropivacaine and 7.53 mg (95%CI, 7.00 - 8.10 mg) for bupivacaine. The relative potency ratio was 0.80 (95%CI, 0.74 - 0.85) for ropivacaine/bupivacaine when given intrathecally in cesarean section.

CONCLUSIONRopivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.

Adult ; Amides ; administration & dosage ; therapeutic use ; Anesthetics, Local ; Bupivacaine ; administration & dosage ; therapeutic use ; Cesarean Section ; methods ; Female ; Humans ; Injections, Spinal ; Pregnancy ; Young Adult

Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens. By reviewing 18 studies, we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain, length of hospital stay and opioid consumption. We conclude that local infiltration analgesia is an effective method for decreasing postoperative pain.
Analgesia ; methods ; Analgesics, Opioid ; therapeutic use ; Anesthetics, Local ; therapeutic use ; Arthroplasty, Replacement, Hip ; Humans ; Length of Stay ; statistics & numerical data ; Pain Management ; methods ; Pain Measurement ; Pain, Postoperative ; prevention & control

Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.
Anesthetics, Local ; Behavior Therapy ; Clomipramine ; therapeutic use ; Ejaculation ; Humans ; Lidocaine ; administration & dosage ; Male ; Prilocaine ; administration & dosage ; Serotonin Uptake Inhibitors ; therapeutic use ; Sexual Dysfunction, Physiological ; psychology ; therapy

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy. Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student's t-test. Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group. Conclusion Perioperative CTPVB markably promotes patient's QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.
Anesthetics, Local/therapeutic use* ; Double-Blind Method ; Hepatectomy/adverse effects* ; Humans ; Morphine/therapeutic use* ; Pain Measurement ; Pain, Postoperative/etiology* ; Ultrasonography, Interventional

BACKGROUNDRopivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia.

METHODSFour hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine (Group B), ropivacaine (Group R) or levobupivacaine (Group L) with sufentanil 0.5 microg/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted.

RESULTSThere were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction (P>0.05). The relative median potency was bupivacaine/ropivacaine: 0.828 (0.602-1.091), bupivacaine/levobupivacaine: 0.845 (0.617-1.12), ropivacaine/levobupivacaine: 1.021 (0.774-1.354), respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of >or=0.1% within each group (P<0.05).

CONCLUSIONSUsing patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine with sufentanil produce similar analgesia and motor block and safety for labor analgesia. The analgesic efficacy mainly depends on the concentration rather than the type of anesthetics.

Adult ; Amides ; therapeutic use ; Analgesia, Epidural ; methods ; Analgesia, Obstetrical ; methods ; Analgesia, Patient-Controlled ; methods ; Anesthetics, Local ; therapeutic use ; Bupivacaine ; analogs & derivatives ; therapeutic use ; Female ; Humans ; Labor Pain ; drug therapy ; Labor, Obstetric ; Pregnancy ; Sufentanil ; therapeutic use ; Young Adult

OBJECTIVETo investigate the effect of epidural ropivacaine in combination with fentanyl for labor analgesia on the clinical outcome of labor.

METHODSA retrospective study was conducted involving 281 healthy primiparas, including 106 undergoing spontaneous labor who received epidural 0.15% ropivacaine in combination with fentany (1microg/ml) and 175 without epidural analgesia. The active phase duration, durations of each labor stages, delivery modes, management of labor, postpartum hemorrhage, incidence of fetal distress and asphyxia neonatorum were recorded in the two groups. The visual analogue scale (VAS) was used to assess the pain of uterine contraction, and modified Bromage scoring system applied to evaluate the lower limb motor block.

RESULTSThere were no significant differences in the duration of the first, third or the total labor stages between the two groups, but the second labor stage was prolonged in the labor analgesia group. The ratio of spontaneous labor, assisted vaginal delivery, and incidence of asphyxia neonatorum were higher, whereas the duration of the active stage was shortened in the analgesia group.

CONCLUSIONEpidural ropivacaine in combination with fentanyl in labor can decrease the incidence of cesarean section, and the duration of the active stage can be shortened with application of ocytocin.

Adult ; Amides ; administration & dosage ; therapeutic use ; Analgesia, Epidural ; methods ; Analgesia, Obstetrical ; methods ; Anesthetics, Combined ; Anesthetics, Intravenous ; administration & dosage ; therapeutic use ; Anesthetics, Local ; administration & dosage ; therapeutic use ; Female ; Fentanyl ; administration & dosage ; therapeutic use ; Humans ; Labor Pain ; drug therapy ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.
Anesthetics, Local/administration & dosage/therapeutic use ; Epinephrine/administration & dosage/therapeutic use ; Humans ; Range of Motion, Articular ; Suture Techniques ; *Tendon Injuries/rehabilitation/surgery ; Tendon Transfer/*methods ; Tendons/*surgery ; Vasoconstrictor Agents/administration & dosage/therapeutic use

OBJECTIVET To evaluate the effect of postoperative analgesia with flurbiprofen axetil combined with sufentanyl in modulating the metabolism of patients undergoing operations for intestinal carcinoma.

METHODSEighty patients undergoing operations for intestinal carcinoma were randomly assigned into two groups, in group A, the patients received postoperative analgesia with flurbiprofen axetil combined with sufentanyl, and in group B, only sufentanyl was given. Parenteral nutrition with restricted nitrogen resource was given in both groups. The Visual Analog Scale (VAS), body temperature and postoperative nitrogen balance were monitored postoperatively, and the concentrations of plasma cortisol, epinephrine, tumour necrosis factor-alpha(TNF-alpha) and interleukin-6 (IL-6) were measured perioperatively.

RESULTSVAS at 24, 48, 72 h after operation were similar between the two groups (P>0.05). The changes in body temperature, nitrogen balance, TNF-alpha and IL-6 after operation were more obvious in group B than in group A, but significantly improved on postoperative day 3 (P<0.05) in the two groups. Flurbiprofen did not result in postoperative increase in cortisol and epinephrine.

CONCLUSIONPostoperative analgesia with flurbiprofen axetil and sufentanyl or with sufentanyl alone produces similar postoperative analgesic effect in patients undergoing operation for intestinal carcinoma, but the former protocol offers better interventional effect on protein catabolism and promotes nitrogen balance.

Adult ; Aged ; Analgesia ; Anesthetics, Local ; therapeutic use ; Carcinoma ; surgery ; Female ; Flurbiprofen ; analogs & derivatives ; therapeutic use ; Humans ; Interleukin-6 ; metabolism ; Intestinal Neoplasms ; surgery ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; metabolism ; Sufentanil ; therapeutic use ; Tumor Necrosis Factor-alpha ; metabolism