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Biomedical subjects

B Borghi

Publications and source records attributed to B Borghi.

At least 19 recordsLinked to original sources
PubMed2006

Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: a prospective, randomized, double-blind comparison between levobupivacaine 0.25%, and ropivacaine 0.25% or 0.4%.

BACKGROUND AND OBJECTIVES: To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery. METHODS: Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment. RESULTS: No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups. CONCLUSION: When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.

Adolescent↗
PubMed2002

Thromboembolic complications after total hip replacement.

We conducted a retrospective analysis of 1,640 consecutive patients undergoing total hip replacement between 1990 and 1997 under general anesthesia and receiving three different prophylactic regimens. The thromboembolic prophylaxis consisted of low-dose unfractioned heparin (UFH), low-molecular-weight heparin (LMWH), or indobufen (INDO). Postoperatively, occurrence of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) was recorded during the first 30 days after surgery and at a routine follow-up visit. Symptomatic DVT was diagnosed in 16 patients (0.9%), while PE occurred in eight patients (0.5%). Patients receiving UFH showed a higher incidence of symptomatic DVT (3.6%) than those patients receiving either LMWH (1.3%) or INDO (0.3%), with an odds ratio for developing symptomatic DVT when receiving UFH versus other treatments of 6.05 (95% confidence intervals [CI95%]: 3.63-10.07) (P=0.001). On the other hand, the diagnosis of PE was more frequently seen in patients receiving cemented hip arthroplasty (2.4%) than in patients receiving uncemented hip arthroplasty (0.34%), with an odds ratio of 3.185 (CI95%: 2.01-5.02)(P=0.05).

Anesthesia, General↗
PubMed2002

Molecular linkage map of Einkorn wheat: mapping of storage-protein and soft-glume genes and bread-making quality QTLs.

Two molecular maps of Triticum monococcum L were produced and integrated. The integrated map includes a total of 477 markers, 32 RFLPs, 438 AFLPs, one morphological (soft glume (Sog)) and six storage-protein markers, and covers 856 cM. The trait Sog with the recessive allele sog maps to linkage group 2S. Probably, this is the T. monococcum homologue of Tg and Tg2 in hexaploid and tetraploid wheats, respectively. Loci coding for seed storage proteins were allocated to chromosomes 1L (HMW GLU1,2 and Glu1), 1S (LMW GLU6,7, LMW GLU1-4, omega GLI1-4, gamma GLI5 and Gli-1) and 6L (alpha/beta GLI7-14). Parameters related to bread-making quality (SDS sedimentation volume, specific sedimentation volume (SSV) and total protein content) were studied in one of the two populations. A QTL that is consistently present across environments was detected for SDS sedimentation volume and for SSV. The position of the QTL on chromosome 1S was in close agreement with the map positions of storage-protein loci. A second QTL was mapped on chromosome 5. For protein content, two significant QTLs were mapped to linkage groups 1 and 5.

Bread↗
PubMed2002

[Epidural vs general anaesthesia].

BACKGROUND: Aim of this study is to determine if and how the anaesthesia technique can significantly influence the outcome in patients after major orthopaedic surgery in terms of: patrimony of red blood cells (blood loss and erythropoiesis), incidence of intra and postoperative complications, postoperative pain control and hospital stay. METHODS: 210 patients, ASA physical status I-III, undergoing elective primary total hip replacement were randomly allocated in three groups of 70 patients to receive either epidural anaesthesia (Group EA), general anaesthesia (GA), or epidural anaesthesia integrated with mild general anaesthesia (IA). RESULTS: Data show a significant difference between the amount of pain measured by VRS immediately after surgery: prevalently absent in groups IA (84.3%) and EA (85.7%) and prevalently severe and moderate in group AG (34.3%). The measurement of the basic circulating erythrocyte mass in the first, third and fifth postoperative day, calculated by the Mercuriali formula, which considers blood loss, autologous and homologous transfusions and erythropoiesis, showed that general anaesthesia leads to a significant delay in the resumption of haemopoiesis. This result was attenuated by its combination with epidural anaesthesia. CONCLUSIONS: On the basis of the literature and the results of our study, epidural anaesthesia seems to be the most appropriate technique for patients scheduled for total hip replacement: due to its simpler analgesic cover, its tendency to be associated with a lower incidence of complications in the first 24 hours after surgery. The incidence of relevant hypotension is minor compared to integrated anaesthesia. General anaesthesia produced a significant decrease in postoperative erythropoiesis.

Aged↗
PubMed2002

[Sedation with magnetic resonance imaging in pediatric patients].

219 children (ASA I-II, age 30 days-12 yrs), underwent deep sedation with intravenous thiopental for magnetic resonance imaging in a hospital setting. Sedation strategies and monitoring are described. The procedure showed to be safe for the patients and cause low artefacts by movements.

Artifacts↗
PubMed2001

Coenzyme Q blocks biochemical but not receptor-mediated apoptosis by increasing mitochondrial antioxidant protection.

Generation of free radicals is often associated with the induction and progression of apoptosis. Therefore, antioxidants can prove anti-apoptotic, and can help to elucidate specific apoptotic pathways. Here we studied whether coenzyme Q, present in membranes in reduced (ubiquinol) or oxidised (ubiquinone) forms, can affect apoptosis induced by various stimuli. Exposure of Jurkat cells to alpha-tocopheryl succinate (alpha-TOS), hydrogen peroxide, anti-Fas IgM or TRAIL led to induction of apoptosis. Cell death due to the chemical agents was suppressed in cells enriched with the reduced form of coenzyme Q. However, coenzyme Q did not block cell death induced by the immunological agents. Ubiquinol-10 inhibited reactive oxygen species (ROS) generation in cells exposed to alpha-TOS, and a mitochondrially targeted coenzyme Q analogue also blocked apoptosis triggered by alpha-TOS or hydrogen peroxide. Therefore, it is plausible that ubiquinol-10 protects cells from chemically-induced apoptosis by acting as an antioxidant in mitochondria. Our results also indicate that generation of free radicals may not be a critical step in induction of apoptosis by immunological agents.

Antioxidants↗
PubMed2001

A new posterior approach to the sciatic nerve block: a prospective, randomized comparison with the classic posterior approach.

UNLABELLED: To evaluate the efficacy and acceptance of a new posterior subgluteus approach to the sciatic nerve, as compared with the classic posterior approach, 128 patients undergoing foot orthopedic procedures were randomly allocated to receive either the classic posterior sciatic nerve block (Group Labat, n = 64) or a modified subgluteus posterior approach (Group subgluteus, n = 64). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 1-0.5 mA). In Group subgluteus, a line was drawn from the greater trochanter to the ischial tuberosity; then, from the midpoint of this line, a second line was drawn perpendicularly and extended caudally for 4 cm. The end of this line represented the needle entry. In both groups, a proper sciatic stimulation was elicited at 0.5 mA; then 20 mL of 0.75% ropivacaine was injected. The time from needle insertion to successful sciatic nerve stimulation was 60 s (range, 10-180 s) with the Labat's approach and 32 s (range, 5-120 s) with the new subgluteus approach (P = 0.0005). The depth of appropriate sciatic stimulation was 45 +/- 13 mm (mean +/- SD) after 2 (range, 1-7) needle redirections in Group subgluteus and 67 +/- 12 mm after 4 (range, 1-10) needle redirections in Group Labat (P = 0.0001 and P = 0.00001, respectively). The failure rate was similar in both groups. Severe discomfort during the procedure was less frequent and acceptance better in Group subgluteus (5 patients [8%] and 60 patients [94%], respectively) than in Group Labat (20 patients [31%] and 49 patients [77%], respectively) (P = 0.0005 and P = 0.005, respectively). We conclude that this new subgluteus posterior approach to the sciatic nerve is an easy and reliable technique and can be considered an effective alternative to the more traditional Labat's approach. IMPLICATIONS: Evaluating the efficacy and acceptance of a new approach to the sciatic nerve block, this prospective, randomized study demonstrated that the new subgluteus posterior approach is an easy and reliable technique and can be considered an useful alternative to the more traditional Labat's approach in patients undergoing foot surgery, facilitating the performance of the sciatic nerve blocks.

Adult↗
PubMed2001

Operator independent left ventricular function monitoring during pharmacological stress echo with the new peak transcutaneous acceleration signal.

BACKGROUND: As the myocardium contracts isometrically, it generates vibrations that can be measured with an accelerometer. The vibration peak, peak endocardial acceleration (PEA), is an index of contractility. OBJECTIVE: To evaluate the feasibility of PEA measured by the cutaneous precordial application of the accelerometer sensor; and to assess the usefulness of PEA monitoring during pharmacological stress echocardiography. DESIGN: Feasibility study. SETTING: Stress echo laboratory. PATIENTS: 34 consecutive patients underwent pharmacological stress (26 with dipyridamole; 8 with dobutamine) and PEA monitoring simultaneously. INTERVENTIONS: A microaccelerometer was positioned in the precordial region and PEA was recorded. Dipyridamole was infused up to 0.84 mg/kg in 10 minutes, and dobutamine up to 40 microg/kg/min in 15 minutes. RESULTS: A consistent PEA signal was obtained in all patients. Overall mean (SD) baseline PEA was 0.26 (0.15) g (g = 9.8 m/s(2)), increasing to 0.5 (0.36) g at peak stress (+0.24 g, 95% confidence interval (CI) 0.14 to 0.34 g; p < 0.01). PEA increased from 0.26 (0.16) to 0.37 (0.25) g in the dipyridamole group (+0.11 g, 95% CI 0.08 to 0.16 g; p < 0.01), and from 0.29 (0.1) to 0.93 (0.37) g in the dobutamine group (+0.64 g, 95% CI 0.37 to 0.91 g; p < 0.01). CONCLUSIONS: Using precordial leads this method offers potential for diagnostic application in the short term monitoring of myocardial function. PEA monitoring is feasible during pharmacological stress and documents left ventricular inotropic response quantitatively in a non-invasive and operator independent fashion.

Acceleration↗
PubMed2001

Levobupivacaine.

Bupivacaine has been the most widely used local anaesthetic for years. Recent studies point out levobupivacaine, an S(-) isomer of the racemic bupivacaine. This review shows the properties of levobupivacaine describing the animal and human volunteers studies on toxicity and the first clinical studies in obstetrics, general surgery and paediatrics. In vitro animal studies show that, injected intravenously, levobupivacaine has less cardiotoxic effects and less toxic effects on the CNS in comparison with both R(+) bupivacaine and bupivacaine itself, caused by a minor affinity for brain tissue resulting in less CNS depressant effects as well as for myocardial tissue, which leads to a higher dose necessary before being lethal in comparison to bupivacaine. Studies in human volunteers confirm these results, adding a minor arrhythmogenic, and less negative inotropic effect. Clinical studies show no significant differences in onset, duration and sensory block, but complete regression of sensory block takes longer. Potency is equal for levo- and bupivacaine according to MLAC in labour analgesia. Studies in paediatrics confirm effective analgesia but show less intensity of motor block. The reduced toxicity of levobupivacaine gives wider safety margin in the daily clinical practice both for single shot and for continuous infusion, intraoperatively during various surgical procedures and for the postoperative pain control and analgesia in labour.

Analgesia↗
PubMed2001

[S(-) bupivacaine (levobupivacaine) in peripheral blocks: preliminary results].

We have compared the onset time, anesthetic potency and adverse effects of three local anaesthetics (ropivacaine, levobupivacaine and bupivacaine) in two type of peripheral blocks (brachial plexus block for upper limb and femoral nerve block for lower limb) in adult patients in a double blind, randomized, prospective study. A total of 66 patients undergoing orthopaedic surgery were randomly allocated to receive brachial plexus block or femoral nerve blockade with 0,5% ropivacaine (group R, n=22), 0,5% levobupivacaine (group L, n=22) or 0,5% bupivacaine (group B, n=22), each groups has been divided into two subgroups (LBP n=11, RBP n=11, BPB n=11, LBF n=11, RBF n=11, BBF n=11) dipending on the type of block. The onset of sensory nerve block was similar for the three groups; the onset of motor block and onset time ready to surgery were faster in group R (-30%) if compared with group L and B. The duration of motor block and sensory block was respectively longer in group L and in group B. Study results have not been influenced by the blocks, except for plexus nerve block where we observed the same results for group B and group R in relation to onset time ready to surgery. VRS scores were higher in group R as showed by the number of analgesic request in postoperative period. We did not observe any adverse effect. We conclude that ropivacaine acts faster with less interpatient variability, while levobupivacaine and bupivacaine offer a prolonged postoperative analgesia. For this reason, with the exception of bupivacaine due to major cardio and neuro toxicity, we can indifferently use levobupivacaine or ropivacaine depending on the requested characteristics of the anesthetic.

Amides↗
PubMed2001

[Loco-regional anaesthesia of the lower limbs].

Lumbar plexus and sacral plexus are responsible for sensory and motor innervation of the whole inferior limb and their blockade can be used as a single technique or integrated with general anaesthesia for hip-, femur-, knee-, lower leg-, ankle- and foot surgery. For the performance of the blocks, knowledge of peripheral and central percourse of the nerves and their anatomical relationships to bone-, muscle-, vessel and skin structures is important. In case of the sciatic nerve, a cutaneous projection of the percourse of the nerve is possible (the so-called sciatic line) formed by a virtual line from the midpoint of the line between great trochanter and ischial tuberosity to the apex of the popliteal fossa. Peripheral blocks used for the above mentioned types of surgery are: lumbar plexus block, sacral plexus block, femoral nerve block, obturator nerve block, lateral cutaneous femoral nerve block and sciatic nerve block. Regarding the last one, the following approaches are possible, depending on the anatomical site of performance: classic proximal posterior block, parasacral proximal block, lithotomic posterior proximal block, subgluteal posterior proximal block, anterior proximal block, lateral medio femoral popliteal proximal block, block distal from the poplitea, subcalcaneal block. The terms distal and proximal are in relation to the small trochanter. All blocks have to be performed using a nerve stimulator, teflon insulated needles of various measures depending on the kind of block, variable stimulation from 1,5 mA (when evoking muscle contraction) to 0,5-0,3 mA (injection of local anaesthetic) with frequencies of 2 Hz/0,1 ms.

Anesthesia, Local↗
PubMed2001

Diagnosis and therapy of intrathecal bleeding.

AIM: Define pathophysiology, epidemiology, diagnosis and therapy in case of spinal bleeding after central neural blockade (CNB). METHODS: Spinal epidural hematoma (SEH) following CNB may occur due to vascular trauma from needle/catheter placement and can occur in subdural and epidural spaces. Epidural artery bleeding seems the source of SEH: the damage mechanism depends on compression and neural vascular ischemia of cord, nerve roots, ganglion and toxicity from blood cell lysis products. Incidence varies (1:150.000 - 1:500.000) but SEH may be asymptomatic. CONCLUSIONS: SEH starts with acute severe low back and/or radicular pain and neurologic signs that may progress to paraparesis, sensory loss and sphincter disturbances. After CNB, the only sign of SEH may be an unusually prolonged motor and sensory block. Symptoms may start even 96 hours after CNB and/or removal of the epidural catheter. Neurological recovery is related to severity and speed of preoperative deficits development and surgical decompression. MR imaging features (diagnostic tool of choice), including degree of cord compression, are useful to establish or confirm the diagnosis of SEH but do not influence the management or predict outcome. Hematoma resolution and severity of neurologic impairment has the greatest impact on management and outcome. Preoperative MRI information and intraoperative evidence of subarachnoid hemorrhage (SAH) and CSF leakage is important: SAH worsens outcome for its negative effect on spinal cord and cauda equina. Conservative therapy may be successful in cases with minimal neurologic deficits, despite cord compression.

Hemorrhage↗
PubMed2001

[Continuous brachial plexus blockade for shoulder surgery].

Continuous brachial plexus block is the technique of choice for postoperative shoulder pain treatment. The localization of the plexus is usually obtained drawing landmarks on the skin and using the electrical nerve stimulator; these and other different modalities are applied in order to reach safely and precisely nerve roots to be blocked with an anaesthetic solution. The Author presents a new anatomical perspective to guide the localization of the brachial plexus. It is shown how it is possible to detect the pathway of the brachial plexus from the cutaneous surface, linking between each other various landmarks: a) the apex of the scalene triangle, at the cross of a line leaving from the cricoid process and directed posterior to the posterior border of the sternocleidomastoid muscle, b) the midline of the clavicle c)the deltoid-pectoral sulcus d) the midpoint between the coracoid process and the chest profile e) the pulsation of the artery in the axylla. Following the guide of the so formed anesthetic line, is possible to place the needle, with a direction from distal to proximal, in a tangential route towards the interscalenic groove, thus allowing to perform a block of the plexus in a simple and efficacious way.

Brachial Plexus↗
PubMed2001

[Peripheral blocks for the lower limb: lumbar plexus].

BACKGROUND: The techniques of continuous peripheral blockades have shown to be efficient in postoperative pain control, in the various orthopaedic procedures of the limbs. The aim of this study is to evaluate the existing data about the use of a continuous blockade of the lumbar plexus or femoral nerve, together with the indications for technique and therapy. METHODS: We considered the principal results of prospective, randomised studies described in literature about the assessment of a continuous peripheral blockade of the lumbar plexus or the femoral nerve in limb surgery. Furthermore we described the principal techniques for positioning the perinerval catheters in the considered sites, and the advised dosage regimen. RESULTS: The various studies report an adequate costs/benefits relation concerning the used techniques. The analysed studies not only report an adequate efficacy of the postoperative pain control, but often show an important benefit in terms of functional recovery of the operated limbs and on final outcome of the patient. CONCLUSIONS: The use of continuous blockades of the lumbar plexus or femoral nerve shows to be an important and effective instrument not only in terms of positive effects on postoperative pain control, but also in terms of relevant advantages concerning final outcome after surgery. Nevertheless these techniques should not be considered as the only approach to postoperative pain in the orthopaedic patient, but have to be included in a global, multidisciplinary and multimodal approach.

Humans↗
PubMed2001

Continuous peripheral block in foot surgery.

Peripheral neural blockade techniques are commonly used procedures to provide perioperative anesthesia and analgesia. Several continuous infusion catheter techniques have been described to extend the use of peripheral neural blockade into the postoperative period as an effective method of providing pain management. The analgesic benefit of continuous local anesthetic peripheral block in the management of postoperative pain is primarily related to the properties of providing intense analgesia thereby reducing perioperative opioid requirements and opioid-related side effects and promoting early recovery of postoperative activity. Continuous peripheral nerve blockade seems to be effective in allowing major foot and ankle surgery to be done particularly on an outpatient basis with greater pain relief. The sciatic nerve is the largest nerve in the body and it lies deep in the posterior thigh. According to its anatomy, the sciatic nerve can then be reached at different levels from the parasacral space to the popliteal fossa, ideally identifying a sciatic line running from the inferior border of the gluteus maximus muscle between the greater throcanter and the ischiatic tuberosity to the popliteal fossa. A variety of continuous peripheral blocks have been described in this paper including continuous sciatic block at several levels (para-sacral nerve block, subgluteal sciatic nerve block) and popliteal nerve block.

Foot↗
PubMed2001

[Patient controlled regional analgesia (PCRA) in surgery of stiff elbow: elastomeric vs electronic pump].

BACKGROUND: Aim of this study is to confront an elastomeric pump at regular infusion controlled by the patient with an electronic pump with self-administration for analgesia, by continuous infraclavicular brachial plexus block, as support for the intensive postoperative physiotherapy. METHODS: With signed informed consent 10 patients undergoing corrective surgery for stiff elbow were included. All patients received ropivacaine 30 ml 0,50% for anaesthesia by infraclavicular block with bicipite twitch, after which a catheter was left in situ. In group 1 analgesia consisted of ropivacaina 0,4% by electronic pump (continuous infusion with self-administration of bolus) at day1 and day2, and by elastomeric pump at 5 ml/h, connected to a three way tap managed by the patient (open-closed) at day3 and day4. Group 2 received at day1 and day2 the elastomeric pump and then the electronic pump. All patients continued at home with the elastomeric pump. Flexion-extension capacity of the elbow, daily consumption of ropivacaine 0,4%, and patients comfort were all evaluated. RESULTS: With the electronic pump, flexion-extension capacity is significantly better compared to elastomeric pump. During the use of the electronic pump, consumption of ropivacaina 0.4% was significantly higher in day2 compared to day1 (physiotherapy started day2); consumption in day3 and Day4 was significantly less compared to day2. All patients preferred the electronic pump for the first two days and then the elastomeric pump. CONCLUSION: PCRA quality is higher with ropivacaine 0,4% during the first phase of recovery. The elastomeric pump instead, insufficient in the first phase, is useful for analgesia at home.

Adult↗