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Biomedical subjects

B Ben-David

Publications and source records attributed to B Ben-David.

At least 37 records · Page 2Linked to original sources
PubMed1996

Spinal bupivacaine in ambulatory surgery: the effect of saline dilution.

The safety of lidocaine spinal anesthesia has recently been called into question by reports of both permanent and transient neurologic toxicity. This study explored the possibility of adapting the longer acting spinal bupivacaine to ambulatory surgery. Sixty patients presenting for ambulatory arthroscopy were randomized to four groups receiving the following spinal anesthetics: Group I (15 mg bupivacaine), 3 mL of 0.5% spinal bupivacaine in 8% dextrose; Group II (10 mg bupivacaine), 2 mL of the 0.5% spinal bupivacaine+1 mL saline; Group III (7.5 mg bupivacaine), 1.5 mL of the 0.5% spinal bupivacaine%1.5 mL saline; Group IV (5 mg bupivacaine), 1 mL of the 0.5% spinal bupivacaine+2 mL saline. Maximum block height was T-5 in Group I versus T-8 in the other groups. Onset times to peak block were similar in all groups and averaged 14 min. Time to two-segment regression, complete regression, micturition, and discharge were significantly reduced from Group I to Group II and from Group II to Group III. Reductions in times between Groups III and IV did not achieve statistical significance. Times from placement of the spinal block until discharge were 471 +/- 35, 260 +/- 15,202 +/- 14, and 181 +/- 8 min, respectively, for the four groups. The intensity of motor block decreased significantly from group to group, such that 13 of the 15 patients in Group IV failed to achieve Bromage level 2 or 3. The intensity of sensory block also decreased from group to group with four patients in Group IV having pain intraoperatively that required further treatment. Therefore, Group III provided the optimum combination of adequate depth of anesthesia and rapid recovery. The results of this study indicate that spinal anesthesia with 7.5 mg of 0.5% bupivacaine in 8% dextrose diluted with an equal volume of saline provides an acceptable spinal anesthetic for ambulatory arthroscopy with a recovery profile appropriate to the ambulatory setting.

Adult↗
PubMed1996

Is preoperative ketorolac a useful adjunct to regional anesthesia for inguinal herniorrhaphy?

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) have become a popular component of analgesia regimens, particularly in combination with narcotics. We questioned whether there might also be a place for their use in conjunction with regional anesthesia and whether there was a preferable route for NSAID administration. METHODS: Ilioinguinal and field blocks were performed preoperatively on seventy patients undergoing outpatient inguinal hernia repair. Patients were divided into a control group who received no ketorolac and four study groups who received a preoperative dose of 30 mg ketorolac by one of the following routes: i.v., i.m., p.o., or intrawound (i.w.). The ketorolac in the i.w group was mixed in the syringe with the local anesthetic used for the field block. i.v. and i.m. groups also received ketorolac at the time of the preoperative regional anesthesia and the PO group received the dose at least one hour preoperatively. All patients received a similar general anesthetic intraoperatively. RESULTS: Postoperative pain scores and analgesic requirements were lowest for the i.m., i.v., and i.w. groups. Pain scores and analgesic requirements for the PO group were less than for the control group but more than for the other three groups. Analgesic efficacy therefore ranked: i.m. = i.v. = i.w. > p.o. > control. Though no differences were found between groups in the time to discharge from the recovery room, the ease of nursing care paralleled the findings for pain scores and analgesia requirements. CONCLUSION: Beyond the analgesia provided by the regional anesthesia of the ilioinguinal and field blocks, the preoperative use of ketorolac further reduced postoperative pain scores and the need for additional postoperative analgesic medication. Comparable outcomes for the i.v., i.m. and i.w. groups indicate the lack of any benefit to concentrating the non-steroidal anti-inflammatory drug at the wound (i.w.) or to achieving high blood levels rapidly (i.v.). In conclusion, ketorolac is a useful supplement to ilioinguinal plus field block regional anesthesia for hernia surgery and is most effective administered parenterally.

Adjuvants, Anesthesia↗
PubMed1996

The combination of morphine with local anaesthetic in rhinoplasty--no evidence of a peripheral morphine effect.

BACKGROUND: The recognition of a peripheral opioid action has prompted a number of clinical reports demonstrating a prolonged analgesic effect of peripheral opiate. As most studies have used a model of intraarticular instillation of narcotic we examined direct morphine infiltration of the surgical site in a unique clinical model. METHODS: Sixty patients undergoing primary rhinoplasty were entered into this prospective, randomized, double-blind study. Patients received a standard protocol of premedication, intravenous sedation, and nasal block. Two 2 ml syringes containing saline or morphine 3 mg in saline were provided for IM injection and for addition to the local anesthetic (IW, intrawound): Group I (control)-saline IW, saline IM; Group II morphine IW, saline IM; Group III-saline IW, morphine IM. Intraoperative assessments included need for further sedation, need for further local anesthetic, and degree of bleeding. Recovery room analgesic requirements, pain scores, and recall of intraoperative pain were recorded prior to discharge. Followup phone calls at 24 hours recorded home pain scores and analgesic use during the first postoperative day. RESULTS: Significantly more patients in Group II (9/20) required supplemental local anesthetic intraoperatively compared to Group I (2/20) and Group III (0/20). Significantly more patients in Group II (6/20) recalled their surgical experience as painful compared to Group I (1/20) and Group III (1/20). Group II patients also evidenced significantly more operative bleeding. There were no differences in postoperative pain scores, but Group I patients required analgesic in the recovery room significantly more than in Groups II and III (85% vs 45% and 50%, respectively). There were no differences between groups in analgesic consumption at home. CONCLUSIONS: The results of this study indicate that the preoperative injection of intrawound morphine in combination with the local anesthetic both promotes bleeding and has an early pain-enhancing effect while providing no late analgesic benefit beyond that of IM morphine.

Adult↗
PubMed1995

Comparison of i.m. and local infiltration of ketorolac with and without local anaesthetic.

We have studied postoperative analgesia in 32 patients undergoing outpatient repair of inguinal hernia. All patients received a standardized general anaesthetic of thiopentone followed by halothane or isoflurane in 70% nitrous oxide and oxygen delivered by face mask or laryngeal mask with spontaneous ventilation. No patient received premedication, opioids or neuromuscular blockers. Before wound closure the surgeon infiltrated 20 ml of a study solution into the wound. The solution contained ketorolac 30 mg in saline, 0.25% bupivacaine and ketorolac 30 mg, 0.25% bupivacaine or saline (control group). The control group received ketorolac 60 mg i.m. at the same time. Pain scores were measured 2, 6 and 24 h after operation. Pain scores for all three active groups were significantly less (P < 0.05) than the control group at all times. There were no significant differences in pain scores at any time between the three study groups. Wound infiltration with ketorolac 30 mg in saline, 0.25% bupivacaine or ketorolac 30 mg with 0.25% bupivacaine provided equivalent analgesia. Wound infiltration with ketorolac 30 mg in saline provided analgesia superior to that of ketorolac 60 mg i.m.

Administration, Topical↗
PubMed1995

The influence of high spinal anesthesia on sensitivity to midazolam sedation.

We tested whether a high spinal anesthesia may alter the susceptibility to the soporific effects of sedatives. Twenty ASA grade I and II women undergoing elective abdominal hysterectomy were randomly allocated into two groups. Patients in Group I were given a subarachnoid injection of 12 mg hyperbaric tetracaine and those patients who after 10 min had a sensory level of T4-6 (10 patients) were included in the study. Ten additional patients (Group II) received no spinal injection. Induction of anesthesia was performed on all patients by injecting 1 mg of midazolam intravenously every 30 s until the patient failed to respond to three repeated commands to squeeze the anesthetist's hand. This was considered the induction dose or end-point for the purposes of the study. Patients were then given a neuromuscular blocker, ventilated with oxygen, nitrous oxide, and a volatile anesthetic, tracheally intubated, and maintained under general anesthesia for the remainder of the operation. The dose of midazolam administered to the point of patient failure to respond to command was 7.6 +/- 0.72 mg SEM for Group I and 14.7 +/- 1.16 mg SEM for Group II, (P < 0.0001). These results support the conclusion that patients having a high spinal anesthetic are more sensitive to the sedative effects of midazolam.

Adult↗
PubMed1995

A comparison of sedation techniques for outpatient rhinoplasty: midazolam versus midazolam plus ketamine.

A total of 859 patients presenting for outpatient rhinoplasty were divided into two groups that received intravenous sedation of midazolam 0.1 mg/kg either with or without ketamine 0.4 to 0.5 mg/kg immediately prior to conduct of the local anesthetic injections and surgery. Additional midazolam was given intraoperatively as needed. No patient received narcotic either as premedication or intraoperatively. Patients were evaluated by the surgeon on their response to the injections and surgery, and patients were given a questionnaire 1 week postoperatively to examine their response to and recall of the procedure. Scoring by both the surgeon and patients revealed that the great majority of patients in both groups had adequate "sedation." Patients from both groups related a high degree of satisfaction (> 90 percent) with the technique of sedation. The differences between the two study groups achieved statistical significance only on 4 of the 12 parameters investigated. Those who had received only midazolam were less likely to vocalize during the surgery or to experience the procedure as being of undue duration. Those who had also received ketamine had a lesser chance of remembering the local anesthetic injections (11.1 versus 19.8 percent) and a lesser likelihood of being dissatisfied with their surgical experience (3.3 versus 7.4 percent). In conclusion, the use of an opioid-free sedative technique of intravenous midazolam was highly successful in meeting the needs of both patients and surgeons. The addition of a single preblock dose of intravenous ketamine to intravenous midazolam sedation for rhinoplasty does not improve intraoperative conditions for the surgeon in terms of patient behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗