The aim of the randomized controlled trial was to test the hypothesis that caudal and minimal effective spinal hyperbaric bupivacaine anaesthesia produce similar level of blockade and can be recommended as alternative methods for adult anorectal surgery. The objectives of the study were as follows: 1. To assess caudal blockade in terms of the rate of success, level and duration of sensory and motor block, clinical profile, and quality of anaesthesia. 2. To determine minimal effective dose of spinal hyperbaric bupivacaine in a randomized, double-blinded controlled trial comparing the clinical effects and quality of sensory and motor block of 7.5 mg, 5 mg, and 4 mg doses of spinal hyperbaric bupivacaine. 3. To study the difference of effects of caudal and low-dose spinal hyperbaric bupivacaine blockade with respect to the rate of success, technical characteristics, level and duration of sensory and motor blockade in a randomized controlled trial. 4. To study the effect of caudal and low-dose spinal hyperbaric bupivacaine blockade on changes in mean arterial blood pressure (BP) and heart rate (HR), rate of postoperative complications and quality of anaesthesia according to the patient and medical staff. Methods. Three separate studies were carried out including 322 adult patients. (1) Caudal blockade for adult anorectal study, a pilot study (1 st study). During the period of 01.2001-06.2002 56 patients were involved, a single shot caudal block was made with 22G 40 mm needle... [to full text]

Methods of regional anaesthesia and regional postoperative analgesia are common in perioperative management of patients in traumatology-orthopaedics. One of most challenging fields of traumatology-orthopaedics is shoulder surgery. Shoulder surgery is associated with intense and long-lasting postoperative pain. It affects patients’ well-being, limits limb function and worsens results of surgical treatment. Determination of optimal methods for postoperative pain relief is very important in clinical practice. Several modern studies compared methods of systemic analgesia with continuous interscalene infusion of bupivacaine 0,15 - 0,25 % solution. Application of these concentrations of bupivacaine resulted in sufficient analgesia but profound motor blockade and anaesthetic toxicity were observed. There are few studies on interscalene infusions of small concentrations of bupivacaine. Data on effects of small doses of bupivacaine on intensity of motor blockade and adjuvant drugs on postoperative analgesia is lacking. AIM OF THE STUDY: to evaluate the quality of post-operative pain treatment after shoulder surgery using continuous perineural infusions of different concentrations (0.1% and 0.15%) of bupivacaine and bupicacaine (0.1%) in combination with adjuvant clonidine and effects on operated hand motor function. To assess clinical advisability of interscalene brachial plexus identification and catheterization using G. Meier’s technique. 159 patients scheduled for elective... [to full text]