1 de junho de 2012

Artigo recomendado: Regional intravenous anesthesia in knee arthroscopy

Mahmut Arslan, Mehmet Cantürk, Dilsen Örnek, Mehmet Gamli, Yasar Pala, Bayazit Dikmen, Meleksah Basaran

CLINICS 2010;65(9):831-835

OBJECTIVE: The goal of the study was to investigate the regional intravenous anesthesia procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain.

MATERIAL/METHOD: Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted. The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5% prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters.

RESULTS: The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer.

CONCLUSION: Regional intravenous anesthesia using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required.

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