Background: Vacuum assisted closure, VAC, is a method which can benefit wound closure. There are not many reliable studies about the effects of VAC in different types of wounds. Previous studies have shown that patients have experienced pain during dressing changes. Aim: The aim of the study was to survey in what kind of wounds the vascular surgery ward have been using VAC, to study the treatment process of VAC and how it has been documented and also to investigate if patients with VAC experienced pain during dressing changes. Method: The patients were chosen from a ledger, which contained 77 patients that had been treated with VAC on the vascular surgery ward. Data were collected with a journal survey protocol. Results: The result is based on 67 patients with a total of 79 wounds. VAC was shown to have a good effect on wound healing and infected surgical wounds were the most commonly wound category undergoing treatment with VAC. There was a lack of documentation concerning VAC and the number of wounds, which were not being measured or photographed, before, during and after VAC was 41, 44 and 56. The complications that occurred was bleeding, the suction cup came off or that the patient experienced great pain. The number of days the wound was treated with VAC differed from one to 70 days. The average of numbers of days treated with VAC was 18,5 days. The dressings were changed most commonly two to three times a week. In 18 wounds (23 %), the patients reported pain during dressing changes. Due to lack of documentation, it was impossible, in 45 cases (57 %) to see if the patient had experienced pain during dressing change. Conclusion: Despite the lack in the documentation about the VAC treatment the study shows good results in the majority of the wounds treated with VAC. Some patients experienced pain during dressing changes and therefore it is important to recognize, treat, evaluate and document this. / Bakgrund: Vacuumassisterad sårbehandling, VAC, är en metod vilken kan underlätta sårläkning. Det har utförts alldeles för få studier med hög kvalitet som har studerat effekterna av behandlingen på olika typer av sår. Tidigare studier har visat att patienter upplever smärta vid omläggning av VAC-svamp. Syfte: Studiens syften var att kartlägga vilka typer av sår den kärlkirurgiska avdelningen behandlar med VAC, studera behandlingsprocessen vid VAC och hur den dokumenteras samt undersöka om patienter upplever smärta i samband med byte av VAC-svamp. Metod: Patienterna valdes ut från en liggare på den kärlkirurgiska avdelningen vilken innehöll 77 patienter. Data samlades in med hjälp av ett journalgranskningsprotokoll. Resultat: Resultatet baseras på 67 patienter vilket innefattar 79 sår. VAC som behandlingsmetod visade sig ha bra effekt på sårläkning av de flesta sår och infekterade operationssår var den sårkategori som genomgick flest behandlingar med VAC. Dokumentationen om VAC var sparsam och de antal sår som varken var mätta eller fotograferade innan, under och efter behandling med VAC upp gick till 41 respektive 44 och 56 sår. De komplikationer som uppstod var blödning, att sugproppen lossnade eller att patienten upplevde stor smärta. Omläggning skedde vanligen två till tre gånger per vecka. Medelvärdet på antalet dagar såret behandlades med VAC uppgick till 18,5 dagar. Antalet dagar såret behandlades med VAC varierade från en till 70 dagar. I 18 fall (23 %) har patienten rapporterat smärta vid omläggning av VAC. I 45 fall (57 %) gick det inte att se om patienten hade känt någon smärta vid omläggning. Slutsats: Trots att dokumentationen om behandlingen var bristfällig på flera plan visar studien ett gott resultat av VAC-behandlingen i majoriteten av de sår som behandlades. Vissa patienter upplevde smärta vid omläggning och därför är det viktigt att uppmärksamma, behandla, utvärdera och dokumentera denna.

Bakgrund:De flesta patienter drabbas av akut smärta vid en höftfraktur. Långvarig smärta upplevs av många patienter med coxartros innan elektiv höftplastik. Upplevelsen av smärta hos dessa patienter är både sjukdoms- och vårdlidande. Författarna av denna systematiska litteraturstudie vill beskriva och förtydliga patienternas upplevelse av smärta och smärtlindring vid höftfraktur och höftplastik. Syfte: Att beskriva patienters upplevesle av smärta och smärtlindring vid höftfraktur eller höftplastik. Metod: Systematisk litteraturstudie. Under datainsamlingen framkom sammanlagt 12 vetenskapliga artiklar som ingick i litteraturstudien. Sökningarna gjordes i databaserna CINAHL och PubMed. Artiklarna kvalitetsgranskades och analyserades. Tre teman framkom: Smärtupplevelsen, mobilisering och kommunikation. Resultat: Smärtan hos patienterna som opererats för höftfraktur/höftplastik är fortfarande en smärtsam upplevelse. Smärtlindringen upplevs av många patienter inte vara tillräcklig. Många avstår smärtlindring av rädsla för biverkningar som kan orsaka konfusion och illamående. Om patienterna inte blir smärtlindrande ordentligt uteblir maximal mobilisering. Slutsats: Att kunna se patientens smärta och att ge en adekvat smärtlindring både för fysisk och psykisk smärta är av stor vikt för att kunna lindra denna. Ny kunskap behövs vad gäller smärtlindring/läkemedels verkan samt ökad kunskap kring bemötande av äldre.

Background: Pain may involve physical, emotional and psychological reactions. Chronic pain can lead to restrictions and problems in everyday life. One of the most common pain states is low back pain. A form of treatment that has been marketed as a charitable and pain reliefing alternative is the Shakti mat. Currently there are no studies on its effects published. Purpose: To see whether treatment with Shakti mat in a person with low back pain has an effect on the experience of the ability in activities of daily life and to see if the psychological factors will change. Method: The participant had to lie on a Shakti mat once a day for four weeks. The participant was asked to complete five questionnaires two weeks before, during intervention and two weeks after treatment. The Tampa Scale: a Measure of Kinesiophobia measures to what degree the participant experiencing pain for movement or to harm itself in motion, Coping Strategies Questionnaire - Catastrophizing scale investigating catastrophizing thoughts in connection with pain perception, Pain Disability Index investigates how the participants’ everyday affected/hampered by pain, Self-Efficacy Scale investigates how sure the participant is in his ability to carry out a task despite pain and a Self-monitoring diary where the perception of its ability in everyday activities, experience after treatment, the type of underlay and if the participant could lie longer on the Shakti mat were judged. Results: The participant’s pain in some everyday activities mitigated while the degree of ability in these increased after four weeks of treatment. The psychological factors had not changed much.

Σύγκριση τεχνικών για την αντιμετώπιση του μετεγχειρητικού πόνου μετά από χολοπαγκρεατική εκτροπή για τη θεραπεία της νοσογόνου παχυσαρκίας, με τη χορήγηση επισκληριδίου αναλγησίας με τοπικό αναισθητικό (λεβοβουπιβακαΐνη) και οπιοειδές (μορφίνη). Εισαγωγή – Σκοπός : Η αντιμετώπιση του μετεγχειρητικού πόνου σε ασθενείς με νοσογόνο παχυσαρκία που υποβάλλονται σε χειρουργεία απώλειας βάρους θα πρέπει να στοχεύει στον αποτελεσματικό έλεγχο του μετεγχειρητικού πόνου, στην πρώιμη επαναλειτουργία του εντέρου και στην ταχύτερη κινητοποίηση των ασθενών, χωρίς να διακινδυνεύεται η μετεγχειρητική αναπνευστική λειτουργία, καθώς είναι υψηλό το ποσοστό των παχύσαρκων ασθενών με Αποφρακτική Άπνοια στον Ύπνο (OSA). Μέχρι σήμερα δεν υπάρχουν επαρκή δεδομένα σχετικά με τη διαχείριση της μετεγχειρητικής αναλγησίας σε ασθενείς με νοσογόνο παχυσαρκία που υποβάλλονται σε ανοικτά χειρουργεία απώλειας βάρους, ιδιαίτερα με την εφαρμογή θωρακικής επισκληριδίου αναλγησίας με μορφίνη και λεβοβουπιβακαΐνη. Υλικό – Μέθοδος : Στην παρούσα προοπτική, τυχαιοποιημένη, διπλή τυφλή μελέτη, 96 ασθενείς με super νοσογόνο παχυσαρκία (BMI ≥ 50kg/m2) και φυσική κατάσταση κατά ASA II-III, που υποβλήθηκαν σε χολοπαγκρεατική εκτροπή με Roux-En-Y γαστρική παράκαμψη, τυχαιοποιήθηκαν σε 6 ομάδες (ομάδες Α-F με 16 ασθενείς ανά ομάδα). Όλες οι ομάδες έλαβαν μετεγχειρητικά θωρακική επισκληρίδιο αναλγησία με συνεχή έγχυση μορφίνης 0,2mg/h σε συνδυασμό με άπαξ δόσεις λεβοβουπιβακαΐνης μέσω PCEA : στις ομάδες A,B και C χορηγήθηκε χαμηλή συγκέντρωση λεβοβουπιβακαΐνης 0,1%, ενώ στις ομάδες D, E και F χορηγήθηκε υψηλή συγκέντρωση λεβοβουπιβακαΐνης 0,2%. Οι ομάδες A και D δεν έλαβαν διεγχειρητικά δόση εφόδου μορφίνης, ενώ οι ομάδες B και Ε έλαβαν 1mg και οι ομάδες C και F 2mg μορφίνης επισκληριδίως, αντίστοιχα. Κατά την μετεγχειρητική περίοδο εκτιμήθηκε η ένταση του πόνου στην ηρεμία και στο βήχα με βάση την κλίμακα VAS, η συνολική κατανάλωση λεβοβουπιβακαΐνης, η αναπνευστική λειτουργία, οι αιμοδυναμικές μεταβολές, ο χρόνος κινητοποίησης του εντέρου και ο χρόνος κινητοποίησης των ασθενών. Η στατιστική επεξεργασία έγινε με τη χρήση ANOVA ακολουθούμενη από post-hoc δοκιμασίες, με τη μέθοδο χ2, και με μη παραμετρικές μεθόδους για πολλαπλές ομάδες. Αποτελέσματα : Η ένταση του μετεγχειρητικού πόνου δεν διέφερε μεταξύ των ομάδων. Διπλασιάζοντας τη συγκέντρωση της λεβοβουπιβακαΐνης από 0,1% (ομάδες A, B και C) σε 0,2% (ομάδες D, E και F) αυξήθηκε σημαντικά η συνολική κατανάλωση της λεβοβουπιβακαΐνης (P < 0,001), χωρίς να βελτιωθεί η αναλγησία. Η αύξηση της περιεγχειρητικής χορήγησης μορφίνης με τη χορήγηση δόσης εφόδου (ομάδες B,C,E,F) και της συγκέντρωσης της λεβοβουπιβακαΐνης (ομάδες D, E, F) οδήγησε σε παράταση του χρόνου επαναλειτουργίας του εντέρου (P < 0.05 to 0.01) και καθυστέρηση στη κινητοποίηση των ασθενών (P < 0.05 to 0.01). Παρά την υψηλή συχνότητα των παχυσάρκων ασθενών με OSA (69% - 81%) μεταξύ των ομάδων, δεν παρατηρήθηκε κανένα επεισόδιο αναπνευστικής καταστολής. Οι αιμοδυναμικές παράμετροι και η μετεγχειρητική αναπνευστική λειτουργία, διατηρήθηκαν σε ασφαλή όρια και δεν διέφεραν μεταξύ των ομάδων. Συμπεράσματα : Η θωρακική επισκληρίδιος αναλγησία με τη χορήγηση άπαξ δόσεων λεβοβουπιβακαΐνης 0,1% μέσω PCEA σε συνδυασμό με συνεχή έγχυση μορφίνης 0,2mg/h, χωρίς δόση εφόδου, είναι ένας αποτελεσματικός και ασφαλής τρόπος μετεγχειρητικής αναλγησίας σε ασθενείς με νοσογόνο παχυσαρκία που υποβάλλονται σε ανοικτά χειρουργεία απώλειας βάρους, καθώς αντιμετωπίζει αποτελεσματικά τον μετεγχειρητικό πόνο, οδηγεί σε πρώιμη επαναλειτουργία του εντέρου, σε ταχύτερη κινητοποίηση των ασθενών, χωρίς να διακυβεύεται η αναπνευστική λειτουργία, ακόμα και στους παχύσαρκους ασθενείς με OSA. / Comparison of techniques for postoperative analgesia management after a weight loss surgery (Βiliary Pancreatic Diversion with Roux-En-Y) by administration of epidural analgesia with local anesthetic (levobupivacaine) and opioid (morphine) Background: Postoperative pain control in morbidly obese patients should aim early mobilization and return of bowel function, without respiratory compromise, as there is a high prevalence of obstructive sleep apnoea (OSA). Up to date, not sufficient data exist regarding postoperative analgesic management of morbid super-obese (MSO) patients undergoing open bariatric surgery, especially with thoracic epidural levobupivacaine combined with morphine. Methods: In a prospective double blind randomised controlled trial, 96 ASA II-III MSO patients undergoing open BPD-RYGBP, were randomly allocated to six groups (n=16). All groups received postoperatively a continuous epidural morphine infusion of 0.2 mg h-1, while groups A - C received additionally 0.1% levobupivacaine and groups D - F 0.2% levobupivacaine via PCEA, respectively. Groups A and D did not receive intraoperative epidural morphine loading, while groups B, E received additionally 1mg and groups C and F 2 mg morphine bolus intra-operatively respectively. VAS at rest and on cough, PCEA drug consumption, haemodynamic profile, pulmonary function, time to return of bowel function and ambulation, were recorded for 48h. Results: Pain scores did not differ among groups. Doubling the concentration of levobupivacaine increased considerably its consumption (P < 0.001), without improving analgesia. The increase in perioperative morphine (groups B,C,E,F) and levobupivacaine doses (groups D-F) led to prolonged time to bowel function (P < 0.05 to 0.01) and ambulation (P < 0.05 to 0.01), respectively. Although obstructive sleep apnoea (OSA) prevalence was 69% to 81% among groups, no incidence of respiratory depression was observed. Haemodynamic profile and pulmonary function were well preserved and did not differ among groups. Conclusions: Thoracic PCEA with 0.1% levobupivacaine combined with a continuous daily epidural morphine dose of 0.2 mg h-1, without morphine loading, is an effective approach regarding adequate pain control, early mobilization and return of bowel function in MSO patients, especially in those with OSA.

In der prospektiven Untersuchung bekommen 50 Patienten ein intraoperativ inseriertes ON-Q® PainBuster® Kathetersystem. Patienten der Verumgruppe erhalten über 72 Stunden postoperativ Ropivacain 0,375 % über das lokale Wundkathetersystem mit einer Flussrate von 5 ml/h, Patienten der Placebogruppe zum Vergleich Natriumchloridlösung 0,9 %. Als Basisanalgesie werden alle Patienten mittels eines oralen Nicht-opioid Analgetikum und intravenösem Piritramid therapiert. Im postoperativen Verlauf von 5 Tagen werden die visuell analoge Schmerzskala bei unterschiedlichen Aktivitäten und der Bedarf von intravenös applizierten Piritramid über die PCA-Pumpe als Ergebnisse evaluiert. Diese Ergebnisse werden mit den aktuellen Analagesieverfahren im Rahmen der Thorax- und Kardiochirurgie verglichen und diskutiert. Mögliche Alternativen werden abschließend aufgezeigt.

The underlying nociceptive mechanisms in temporomandibular joint (TMJ) and masticatory muscles in many pain conditions are still unclear, largely due to the limited study of peripheral and central neural mechanisms affecting craniofacial musculoskeletal tissues. This study provided evidence in support of Hypothesis 1: Peripheral glutamatergic and capsaicin-sensitive mechanisms modulate the properties of primary afferents and brainstem neurons processing deep craniofacial nociceptive information. Effects of glutamate and capsaicin injected into the receptive field of deep craniofacial nociceptive afferents or TMJ of TMJ-responsive nociceptive neurons in trigeminal subnucleus caudalis/upper cervical cord (Vc/UCC) were studied in halothane-anesthetized rats. When injected alone, glutamate and capsaicin activated and induced peripheral sensitization in many afferents. Following glutamate injection, capsaicin-evoked activity was greater than that evoked by capsaicin alone, whereas following capsaicin injection, glutamate-evoked responses were similar to those of glutamate alone. When injected alone, glutamate and capsaicin also activated and induced central sensitization in most Vc/UCC neurons. Following glutamate injection, capsaicin evoked greater activity and less sensitization compared with capsaicin alone, whereas following capsaicin, glutamate was less effective in activating and sensitizing most Vc/UCC neurons. This apparent desensitizing effect of capsaicin on glutamate-evoked excitability of Vc/UCC neurons contrasts with the lack of capsaicin-induced modulation of glutamate-evoked afferent excitability, suggesting that peripheral and central sensitization may be differentially involved in the nociceptive effects of glutamate and capsaicin applied to deep craniofacial tissues. Further evidence of glutamate-capsaicin interactions was documented in the attenuation by TMJ pre-injection of glutamate receptor antagonists of jaw muscle activity reflexly evoked by TMJ injection of capsaicin. Moreover, additional findings support Hypothesis 2: Surgical cutaneous incision modulates the properties of brainstem neurons processing deep craniofacial nociceptive information. TMJ-responsive nociceptive Vc/UCC neurons could be activated by surgical incision of the skin overlying the TMJ and this incision-induced afferent barrage caused nociceptive neurons to be temporarily refractory to further capsaicin-induced central sensitization. These novel findings suggest that peripheral glutamate and capsaicin receptor mechanisms as well as surgical cutaneous incision may be involved in the nociceptive processing of deep craniofacial afferent inputs and may interact to modulate both activation as well as sensitization evoked from these tissues.

The underlying nociceptive mechanisms in temporomandibular joint (TMJ) and masticatory muscles in many pain conditions are still unclear, largely due to the limited study of peripheral and central neural mechanisms affecting craniofacial musculoskeletal tissues. This study provided evidence in support of Hypothesis 1: Peripheral glutamatergic and capsaicin-sensitive mechanisms modulate the properties of primary afferents and brainstem neurons processing deep craniofacial nociceptive information. Effects of glutamate and capsaicin injected into the receptive field of deep craniofacial nociceptive afferents or TMJ of TMJ-responsive nociceptive neurons in trigeminal subnucleus caudalis/upper cervical cord (Vc/UCC) were studied in halothane-anesthetized rats. When injected alone, glutamate and capsaicin activated and induced peripheral sensitization in many afferents. Following glutamate injection, capsaicin-evoked activity was greater than that evoked by capsaicin alone, whereas following capsaicin injection, glutamate-evoked responses were similar to those of glutamate alone. When injected alone, glutamate and capsaicin also activated and induced central sensitization in most Vc/UCC neurons. Following glutamate injection, capsaicin evoked greater activity and less sensitization compared with capsaicin alone, whereas following capsaicin, glutamate was less effective in activating and sensitizing most Vc/UCC neurons. This apparent desensitizing effect of capsaicin on glutamate-evoked excitability of Vc/UCC neurons contrasts with the lack of capsaicin-induced modulation of glutamate-evoked afferent excitability, suggesting that peripheral and central sensitization may be differentially involved in the nociceptive effects of glutamate and capsaicin applied to deep craniofacial tissues. Further evidence of glutamate-capsaicin interactions was documented in the attenuation by TMJ pre-injection of glutamate receptor antagonists of jaw muscle activity reflexly evoked by TMJ injection of capsaicin. Moreover, additional findings support Hypothesis 2: Surgical cutaneous incision modulates the properties of brainstem neurons processing deep craniofacial nociceptive information. TMJ-responsive nociceptive Vc/UCC neurons could be activated by surgical incision of the skin overlying the TMJ and this incision-induced afferent barrage caused nociceptive neurons to be temporarily refractory to further capsaicin-induced central sensitization. These novel findings suggest that peripheral glutamate and capsaicin receptor mechanisms as well as surgical cutaneous incision may be involved in the nociceptive processing of deep craniofacial afferent inputs and may interact to modulate both activation as well as sensitization evoked from these tissues.

Artroskopinė priekinio kryžminio raiščio rekonstrukcija – viena iš dažniausiai atliekamų ortopedinių operacijų. Adekvati skausmo kontrolė yra svarbi siekiant efektyvios ankstyvos reabilitacijos ir gerų funkcinių rezultatų, sutrumpinant gydymo ligoninėje trukmę. Atlikome randomizuotą perspektyvųjį dvigubai aklą placebu kontroliuojamą tyrimą panaudodami intrasąnarinius vaistus (morfiną ir neostigminą), derindami su vienkartine šlauninio nervo blokada. Taip pat tyrėme tęstinį skausmo malšinimą šlaunies perineuriniu kateteriu, taikydami du skirtingus paciento kontroliuojamos analgezijos režimus. Taikėme mažesnę vietinio anestetiko koncentraciją, siekdami selektyvesnės sensorinės blokados, mažesnės paros dozės, mažiau toksinių reakcijų. Tikrinome, ar tęstinis skausmo malšinimas yra veiksmingesnis nei vienkartinė nervo blokada su intrasąnarinėmis analgetikų injekcijomis. Intrasąnarinis morfinas turėjo panašų analgezinį poveikį kaip ir neostigminas paciento krūvio metu per visą tyrimo laiką (48 val.); tačiau neostigminas buvo patikimai efektyvesnis už placebą antrą pooperacinę dieną. Skausmo kontrolė ramybėje ir krūvio metu bei pacientų pasitenkinimas per visą tyrimą buvo geresni perineurinio skausmo malšinimo grupėse negu intrasąnarinėse. Intrasąnarinių grupių pacientų analgezijos efektyvumui priartėjus prie kateterinių grupių, nustatydavome didesnį papildomų analgetikų suvartojimą pirmosiose. Skausmo malšinimas 0,1% bupivakaino infuzija šlaunies perineuriniu kateteriu, taikant... [toliau žr. visą tekstą] / Choice of optimal postoperative analgesia technique after anterior crutiate ligament repair remains challenging. Aiming to evaluate and compare the efficacy of intra-articular injection of morphine and neostigmine our prospective randomized clinical study compared pain intensity, consumption of adjunct analgesics and patient satisfaction during 48 postoperative hours in patients who, in addition to spinal block, received a single-shot femoral nerve block followed by the end-of-surgery intra-articular injection of morphine, neostigmine or placebo. Additionally, the former two were compared with continuous femoral nerve block with postoperative patient controlled analgesia infusion pump containing 0.1 % bupivacaine preset in 2 different regimens: with or without basal infusion. Our results show that there was only a single difference among intra-articular groups found on the 2nd postoperative day: a significantly better pain control at motion in neostigmine group than in the placebo group. There was no additive analgesic effect of i/a morphine. Also, we observed a significantly better pain control and patient satisfaction in continuous femoral perineural block PCA groups during the whole trial. There was a significant prevalence of the PCA analgesia regimen which implies the preset basal rate of 0.1% bupivacaine: a 5 ml bolus with a lockout period 30 min and basal infusion 5 ml/h.

Choice of optimal postoperative analgesia technique after anterior crutiate ligament repair remains challenging. Aiming to evaluate and compare the efficacy of intra-articular injection of morphine and neostigmine our prospective randomized clinical study compared pain intensity, consumption of adjunct analgesics and patient satisfaction during 48 postoperative hours in patients who, in addition to spinal block, received a single-shot femoral nerve block followed by the end-of-surgery intra-articular injection of morphine, neostigmine or placebo. Additionally, the former two were compared with continuous femoral nerve block with postoperative patient controlled analgesia infusion pump containing 0.1 % bupivacaine preset in 2 different regimens: with or without basal infusion. Our results show that there was only a single difference among intra-articular groups found on the 2nd postoperative day: a significantly better pain control at motion in neostigmine group than in the placebo group. There was no additive analgesic effect of i/a morphine. Also, we observed a significantly better pain control and patient satisfaction in continuous femoral perineural block PCA groups during the whole trial. There was a significant prevalence of the PCA analgesia regimen which implies the preset basal rate of 0.1% bupivacaine: a 5 ml bolus with a lockout period 30 min and basal infusion 5 ml/h. / Artroskopinė priekinio kryžminio raiščio rekonstrukcija – viena iš dažniausiai atliekamų ortopedinių operacijų. Adekvati skausmo kontrolė yra svarbi siekiant efektyvios ankstyvos reabilitacijos ir gerų funkcinių rezultatų, sutrumpinant gydymo ligoninėje trukmę. Atlikome randomizuotą perspektyvųjį dvigubai aklą placebu kontroliuojamą tyrimą panaudodami intrasąnarinius vaistus (morfiną ir neostigminą), derindami su vienkartine šlauninio nervo blokada. Taip pat tyrėme tęstinį skausmo malšinimą šlaunies perineuriniu kateteriu, taikydami du skirtingus paciento kontroliuojamos analgezijos režimus. Taikėme mažesnę vietinio anestetiko koncentraciją, siekdami selektyvesnės sensorinės blokados, mažesnės paros dozės, mažiau toksinių reakcijų. Tikrinome, ar tęstinis skausmo malšinimas yra veiksmingesnis nei vienkartinė nervo blokada su intrasąnarinėmis analgetikų injekcijomis. Intrasąnarinis morfinas turėjo panašų analgezinį poveikį kaip ir neostigminas paciento krūvio metu per visą tyrimo laiką (48 val.); tačiau neostigminas buvo patikimai efektyvesnis už placebą antrą pooperacinę dieną. Skausmo kontrolė ramybėje ir krūvio metu bei pacientų pasitenkinimas per visą tyrimą buvo geresni perineurinio skausmo malšinimo grupėse negu intrasąnarinėse. Intrasąnarinių grupių pacientų analgezijos efektyvumui priartėjus prie kateterinių grupių, nustatydavome didesnį papildomų analgetikų suvartojimą pirmosiose. Skausmo malšinimas 0,1% bupivakaino infuzija šlaunies perineuriniu kateteriu, taikant... [toliau žr. visą tekstą]

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