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Now showing items 1 - 14 of 14

  • Cerebrospinal fluid density influences extent of plain bupivacaine spinal anesthesia.

    Schiffer, Eduardo   Van Gessel, Elisabeth   Fournier, Roxane   Weber, Anne   Gamulin, Zdravko  

    BACKGROUND: The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine. The ancillary endpoints were search of factors explaining the interindividual differences in cerebrospinal fluid density values reported and determination of the relation between upper extent and regression of spinal anesthesia.METHODS: Sixty-four consecutive patients undergoing peripheral orthopedic surgery with spinal block were enrolled. Spinal anesthesia was performed in the lateral decubitus position with the operated side upward. Two milliliters of cerebrospinal fluid was sampled before injection of 3 ml plain bupivacaine 0.5%. The patient was immediately turned supine and remained in the horizontal position until the end of the study. Maximal sensory block level and time to sensory regression to L4 were determined for each patient enrolled. Cerebrospinal fluid and bupivacaine densities as well as cerebrospinal proteins, glucose, sodium, and chloride concentrations were measured.RESULTS: A highly significant correlation between cerebrospinal fluid density and maximal sensory block level was found (P = 0.0004). However, this correlation was poorly predictive (R(2) = 0.37). Cerebrospinal fluid density, proteins, and glucose concentrations were significantly higher in men than in women: 1.000567 +/- 0.000091 versus 1.000501 +/- 0.000109 g/ml (P = 0.014), 0.46 +/- 0.18 versus 0.32 +/- 0.13 g/l (P = 0.001), and 3.27 +/- 0.7 versus 2.93 +/- 0.5 mM (P = 0.023), respectively. A highly significant (P = 0.0004) and predictive (R(2) = 0.73) inverse correlation was found between maximal upper sensory extent and sensory regression to L4.CONCLUSION: These findings indicate an influence of cerebrospinal fluid density on subarachnoid distribution of 3 ml plain bupivacaine 0.5% and show that with higher cerebrospinal fluid densities, a higher spinal block level can be expected.
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  • Respiratory Depression After 5 [micro sign]g of Intrathecal Sufentanil

    Fournier, Roxane   Gamulin, Zdravko   Van Gessel, Elizabeth  

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  • Respiratory Depression After 5 [micro sign]g of Intrathecal Sufentanil

    Fournier, Roxane   Gamulin, Zdravko   Van Gessel, Elizabeth  

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  • No Differences Between 20, 30, or 40 mL Ropivacaine 0.5% in Continuous Lateral Popliteal Sciatic-Nerve Block

    Fournier, Roxane   Weber, Anne   Gamulin, Zdravko  

    Background and Objectives: The aim of this study was to compare the anesthetic and analgesic characteristics of the administration of an initial bolus of 20, 30, or 40 mL of ropivacaine 0.5% through a lateral popliteal sciatic catheter. Methods: Sixty patients scheduled for foot surgery under continuous sciatic lateral popliteal nerve block were included in this double-blinded study. Patients were randomly assigned to 1 of 3 groups: 20 mL, 30 mL, or 40 mL of ropivacaine 0.5%. Time to obtain a complete sensory block and duration of analgesia were recorded. Failure of the continuous block and complications such as technical or neurologic problems were noted. Results: Data are presented as mean +/- SD, median and ranges, or percent of patients and were compared by application of analysis of variance or Kruskal-Wallis when required. Time to complete sensory block (31 [10-70] v 25 [5-50] v 25 [5-40] min), percentage of failure (5% v 5% v 0%), and duration of action (995 [278-1,800] v 967 [420-2,175] v 915 [190-1,900] min) were not statistically different between 20 mL, 30 mL, and 40 mL ropivacaine 0.5% groups, respectively. No complications were noted. Conclusions: This dose-response study shows that 20 mL of ropivacaine 0.5% injected through an indwelling lateral popliteal catheter is the optimal dose for foot surgery. Higher doses of 30 mL or 40 mL did not provide any further advantage.
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  • A Comparison of Intrathecal Analgesia with Fentanyl or Sufentanil After Total Hip Replacement

    Fournier, Roxane   Van Gessel, Elizabeth   Weber, Anne   Gamulin, Zdravko  

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  • A Comparison of Intrathecal Analgesia with Fentanyl or Sufentanil After Total Hip Replacement

    Fournier, Roxane   Van Gessel, Elizabeth   Weber, Anne   Gamulin, Zdravko  

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  • Intrathecal Sufentanil Is More Potent Than Intravenous for Postoperative Analgesia After Total-Hip Replacement

    Fournier, Roxane   Weber, Anne   Gamulin, Zdravko  

    Background and objectives: In our clinical experience, sufentanil is more effective when administered intrathecally than intravenously. To test this hypothesis, we compared the analgesic characteristics of 7.5 mu g of intrathecal or intravenous sufentanil for pain relief after total-hip replacement. Methods: A randomized, double-blind study was conducted of 40 patients older than 75 years who experienced total-hip arthroplasty in which continuous spinal anesthesia was administered. In the recovery room, as soon as a pain score higher than 3 on a scale of 10 on a visual analog scale was reported, either 7.5 mu g intrathecal or 7.5 mu g intravenous sufentanil were given. If the pain score remained higher than 3 at 20 minutes after sufentanil administration, 1.25 mg of "rescue" intrathecal bupivacaine were given. Results: During the first 20 minutes after intrathecal or intravenous injection, a significantly faster relief of pain was observed for the intrathecal group from 2.5 until 20 minutes. Significantly, more patients needed rescue bupivacaine in the intravenous group (7 of 20 v 0 of 20, P < .008), whereas significantly more patients in the intrathecal group reached a pain score of 0 (20 of 20 v 9 of 20, P < .001). The time to the first analgesic intervention for a pain score greater than 3 was significantly longer in the intrathecal group (224 100 v 98 +/- 60 minutes, P < .001). Pruritus was observed only in 5 patients of the intrathecal group (P < .047), whereas peripheral oxygen saturation under 95% was observed only in 6 patients in the intravenous group (P < .045). Conclusions: After total-hip replacement, intrathecal route of sufentanil administration rapidly offers excellent analgesia of better quality and longer duration when compared with the intravenous route.
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  • Perioperative intravenous low‐dose ketamine for neuropathic pain after major lower back surgery: A randomized, placebo‐controlled study

    Czarnetzki, Christoph   Desmeules, Jules   Tessitore, Enrico   Faundez, Antonio   Chabert, Jocelyne   Daali, Youssef   Fournier, Roxane   Dupuis‐Lozeron, Elise   Cedraschi, Christine   Richard Tramèr, Martin  

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  • Room A, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Intrathecal Sufentanil Alone, with Epinephrine or Clonidine for Postoperative Analgesia after Total Hip Replacement

    Fournier, Roxane   Gamulin, Zdravko   Weber, Anne   Gessel, Elizabeth Van  

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  • Levobupivacaine 0.5% Provides Longer Analgesia After Sciatic Nerve Block Using the Labat Approach Than the Same Dose of Ropivacaine in Foot and Ankle Surgery

    Fournier, Roxane   Faust, Alexandre   Chassot, Olivier   Gamulin, Zdravko  

    BACKGROUND: Levobupivacaine and ropivacaine are 2 left enantiomeric molecules frequently used for peripheral nerve blocks because of their safe clinical profile. Levobupivacaine is more lipophilic and theoretically more potent than ropivacaine, but clinical studies show conflicting results in terms of anesthetic and analgesic characteristics. We hypothesized that the pure S-enantiomer of bupivacaine provides longer-lasting analgesia than ropivacaine. METHODS: We compared the analgesic characteristics of 20 mL levobupivacaine versus 20 mL ropivacaine 0.5% in a posterior sciatic nerve block (Labat approach) for foot and ankle surgery. In a double-blind, randomized, prospective design, 80 patients received either substance. We assessed the onset, duration, and success of the block, and the need for rescue analgesia and technical or neurologic complications over 24 hours. RESULTS: The onset of sensory block (minutes) and the success rate were similar in levobupivacaine and ropivacaine groups (onset, 15 minutes [5-40 minutes] vs 15 minutes [5-60 minutes], respectively; success rate, 90% vs 92.5%). The average time for the first request of pain medication provided by 20 mL levobupivacaine 0.5% was significantly longer than with ropivacaine (1605 minutes [575-2400 minutes] vs 1035 minutes [590-1500 minutes], P < 0.001). The need for postoperative rescue analgesia was higher in the ropivacaine group (37 of 40 [92.5%] vs 30 of 40 [75%], P < 0.034). No complications were noted in either group at 24 hours. CONCLUSION: Twenty milliliters levobupivacaine 0.5% in posterior gluteal (Labat) sciatic nerve block provided longer-lasting analgesia after foot and ankle surgery compared with the same dose of ropivacaine. (Anesth Analg 2010;110:1486-9)
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  • Ultrasound-guided continuous interscalene block: the influence of local anesthetic background delivery method on postoperative analgesia after shoulder surgery: a randomized trial.

    Hamdani, Mehdi   Chassot, Olivier   Fournier, Roxane  

    BACKGROUND: Automated bolus delivery has recently been shown to reduce local anesthetic consumption and improve analgesia, compared with continuous infusion, in continuous sciatic and epidural block. However, there are few data on the influence of local anesthetic delivery method on local anesthetic consumption following interscalene blockade. This randomized, double-blind trial was designed to determine whether hourly automated perineural boluses (4 mL) of local anesthesia delivered with patient-controlled pro re nata (PRN, on demand) boluses would result in a reduction in total local anesthesia consumption during continuous interscalene blockade after shoulder surgery compared with continuous perineural infusion (4 mL/h) plus patient-controlled PRN boluses.; METHODS: One hundred one patients undergoing major shoulder surgery under general anesthesia with ultrasound-guided continuous interscalene block were randomly assigned to receive 0.2% ropivacaine via interscalene end-hole catheter either by continuous infusion 4 mL/h (n =3D 50) or as automated bolus 4 mL/h (n =3D 51). Both delivery methods were combined with 5 mL PRN boluses of 0.2% ropivacaine with a lockout time of 30 minutes. Postoperative number of PRN boluses, 24- and 48-hour local anesthetic consumption, pain scores, rescue analgesia (morphine), and adverse events were recorded.; RESULTS: There were no significant differences in either the number of PRN ropivacaine boluses or total 48 hour local anesthetic consumption between the groups (18.5 [11-25.2] PRN boluses in the continuous infusion group vs 17 [8.5-29] PRN boluses in the automated bolus group). Postoperative pain was similar in both groups; on day 2, the median average pain score was 4 (2-6) in the continuous infusion group versus 3 (2-5) in the automated bolus group (P =3D 0.54). Nor were any statistically significant intergroup differences observed with respect to morphine rescue, incidence of adverse events, or patient satisfaction.; CONCLUSIONS: In continuous interscalene blockade under ultrasound guidance after shoulder surgery, automated boluses of local anesthetic combined with PRN boluses did not provide any reduction in local anesthetic consumption or rescue analgesia, compared with continuous infusion combined with PRN boluses.=20
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  • Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on post-operative analgesia after total knee arthroplasty

    Novello-Siegenthaler, Alessandra   Hamdani, Mehdi   Iselin-Chaves, Irène   Fournier, Roxane  

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  • Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on post-operative analgesia after total knee arthroplasty.

    Novello-Siegenthaler, Alessandra   Hamdani, Mehdi   Iselin-Chaves, Irene   Fournier, Roxane  

    BACKGROUND: Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24h compared with end-hole catheter.; METHODS: Eighty adult patients (aged =E2=89=A518years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN, 20G - 400mm) or an end-hole (Silverstim VYGON, 20G - 500mm) catheter. Once the femoral catheter was sited, a bolus of 20mL lidocaine 1% was injected. An electronic pump then delivered an automated 5mL bolus of ropivacaine 0.2% hourly, with 10mL self-administered patient controlled analgesia boluses.; RESULTS: There was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24h (4(2-7) vs. 4(2-8) in six-hole and end-hole groups, respectively; P=3D0.832) or median ropivacaine consumption at 48h (365(295-418) vs. 387(323-466); P=3D0.452). No significant differences were recorded between the groups at 24h regarding median average verbal rate pain scale (2(0-3) vs. 2(0-4); P=3D0.486) or morphine consumption (0(0-20) vs. 0(0-20); P=3D0.749). Quadriceps muscle strength declined to 7% (0-20) and 10% (0-28) in the six-hole and end-hole groups, respectively, at 24h after surgery (P=3D0.733).; CONCLUSIONS: In this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness.; TRIAL REGISTRATION: Retrospectively registered at ( NCT03376178 ). Date: 21 November 2017.=20
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  • Morphological control of hydrothermal Ni(OH)(2) in the presence of polymers and surfactants: Nanocrystals, mesocrystals, and superstructures RID E-8758-2011 RID A-6966-2012

    Buscaglia, Maria Teresa   Buscaglia, Vincenzo   Bottino, Carlo   Viviani, Massimo   Fournier, Roxane   Sennour, Mohamed   Presto, Sabrina   Marazza, Rinaldo   Nanni, Paolo  

    Polymers with different hydrophilic groups [polyvinylpyrrolidone (PVP), ammonium polyacrylate (APA), and hydroxypropylmethyl cellulose (HPMC)] and surfactants [cetyltrimethylammonium bromide (CTAB) and sodium dodecylbenzensulfonate (SDBS)] were used as additives to modify the crystallization of beta-Ni(OH)(2) in hydrothermal conditions. Marked morphological changes in the beta-Ni(OH)(2) particles were observed depending on the additive concentration and on the duration of the hydrothermal treatment. The final morphology is the result of a complex, time-dependent self-assembly and growth process. Well-defined particles with sizes from submicrometer range to a few micrometers corresponding to hexagonal lamellae, hexagonal tabular mesocrystals, rosette- and flowerlike aggregates of lamellae, hexagonal prismatic mesocrystals, and acicular nanocrystals were easily obtained after a short time (2-24 h) aging at 150-200 degrees C. With PVP and CTAB, there is evidence of a growth process dominated by self-assembly of nanocrystals to produce mesocrystals. The formation of spherical superstructures (with SDBS, up to 70 mu m in diameter) and hollow spheres (with PVP) is observed at long times (>24 h) as a result of solvent-mediated recrystallization processes, like Ostwald ripening. The overall results show that hydrothermal synthesis of beta-Ni(OH)(2) in the presence of polymers with hydrophilic groups and surfactants is a versatile tool for crystal morphogenesis.
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