Biomedical subjects

A Rocco

Publications and source records attributed to A Rocco.

59 records · Page 4Linked to original sources

PubMedDate not supplied

Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery.

AIM: Levobupivacaine, a new local anaesthetic, has been recently introduced into clinical practice because of its lower toxic effects for heart and central nervous system. It has been already investigated in epidural and loco-regional techniques, but more has to be known regarding its characteristics in spinal anaesthesia. The aim of our study was to compare clinical and anaesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in 60 patients undergoing major orthopaedic surgical procedures. METHODS: Three ml of glucose-free levobupivacaine 0.5% (group L) or 3 ml of isobaric bupivacaine 0.5% (group B) were administered in 30 patients each. Sensory and motor blockades were evaluated by the pinprick test and a modified Bromage score, respectively. Vital parameters, postoperative VAS and rescue analgesia were recorded as well. RESULTS: No statistically significant differences between groups were observed either in anaesthetic potencies or postoperative pain. Either heart rate or mean arterial pressure slightly decreased in both groups, with no preoperative significant differences. Nevertheless, spinal puncture was accompanied by severe hypotension and bradycardia in 2 patients of group B. In both cases, hemodynamics were promptly and successfully treated, with no sequelae. CONCLUSIONS: In conclusion, levobupivacaine results a valid alternative to racemic bupivacaine for spinal anaesthesia, the latter remaining a cheap and effective local anaesthetic yet. Notwithstanding the complete absence of any significant hemodynamic complications in the patients of group L, further and larger studies are needed in order to assess if levobupivacaine is preferable to bupivacaine for minimizing the possible cardiovascular impact of spinal anaesthesia.

Adult↗

PubMedDate not supplied

Interpleural bupivacaine for postoperative analgesia following cholecystectomy: a randomized prospective study.

The effect of interpleural analgesia on postoperative hospital course was analyzed ina prospective randomized study of patients undergoing cholecystectomy. Control patients were treated in the standard manner with systemic narcotics alone; catheter patients had an interpleural catheter placed at the end of surgery and, in addition, could receive systemic narcotics if necessary. The catheter group received interpleural 0.5% bupivacaine with epinephrine every six hours for a total of four injections. Thirteen patients were in each group. Pain score, pulmonary function and narcotic requirement were measured over the first postoperative day. Catheter patients had a lower average pain score (visual analog scale (VAS), 3.6 versus 5.2), decreased narcotic requirement in the recovery room and improved oxygen saturation (96% versus 93%). However, there was no statistical difference in amount of morphine (catheter, 25 +/- 14 mg; control, 31 +/- 15 mg), number of narcotic injections (catheter, 3.8 +/- 1.5; control, 3.5 +/- 1.5), forced vital capacity (catheter, 44% preoperative control, 41% preoperative), recovery room time (catheter, 129 +/- 54 minutes, control, 117 +/- 39 minutes) or total hospital stay (catheter, 4.1 +/- 0.9 days; control, 3.7 +/- 0.8 days). Analysis of hourly VAS scores following a bolus indicated that the analgesia disappeared within approximately four hours. The mean time to a request for narcotic following a bolus was 4.2 hours (excluding 17 of a potential total of 52 instances when narcotic was not requested at all). Therefore, the duration of pain relief for subcostal incisions using interpleural 0.5% bupivacaine is approximately four hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Non-recurrent inferior laryngeal nerve].

The Authors describe a case of non recurrent inferior laryngeal nerve located on the right side observed during anatomical studies of the innervation of the larynx. The description is accompanied by photographic documentation which shows the anomalous course of the nerve and its abnormal relationship with the right subclavian artery, also anomalous. The embryological nature of such anatomical variations is discussed followed by considerations concerning possible consequences with regard to clinical aspects and thyroid surgery. Furthermore, the Authors indicate clinical signs that may suggest the presence of such anomaly so as to avoid anatomical or functional damage of the nerve which, although anomalous, plays an important role in coordinating breathing and phonation.

Humans↗

PubMedDate not supplied

[The anastomotic loop between recurrent laryngeal nerves: an anatomic reality].

The authors present the result of an anatomical study carried out on human laryngeal nerves. During the study, stressed not only were classic anatomical data relating to the morphology of the nervous system of the larynx, evidentiated and photographically documented, but the constant presence of an anastomotic nervous loop between the two recurrent nerves was revealed as well. This loop has been mentioned only in the most recent specialized Literature. Analysis was carried out on thirteen fresh anatomical models, taken from 13 corpses (7 men and 6 women aged from 48 to 84) during autopsy. The first phase dissection carefully eliminated those tissues not directly related to the nervous formations which were, however, subsequently analysed in detail. The superior laryngeal nerves, the recurrent nerves and the collateral ramification were then totally isolated. The anastomotic loop in question links the two recurrent nerves at the crossing of the oesophagus-tracheal virtual space. It appears to originate on the right as well as on the left side, respectively at the cervicodiastinal junction level and in the thorax. The anastomosis was isolated in each specimen. Its constant presence and its morphology should be proof enough of its being an anatomical and surgical reality. Only in one case did the loop pass in front of trachea instead of crossing the oesophagus-tracheal space, while maintaining, however, the same inclination and morphology. A future, wider study should focus on the understanding of the loop's function, as well as of its possible utilization in surgical therapy of laryngeal paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

[Outbreak of carpal tunnel syndrome of the upper limbs in automobile seat assemblers: results of exposure evaluation and clinical investigation].

A group of 59 female workers in the sewing and upholstery departments of a factory manufacturing automobile seats underwent clinical and instrumental tests following reports of several cases of suspected carpal tunnel syndrome. A risk evaluation analysis for disorders attributable to repeated trauma of the upper limbs (WMSDs) was simultaneously carried out using the protocol recommended by the EPM Research Unit in Milan. Evidence was found of a high frequency of elementary actions associated with considerable muscular involvement along with inadequate recovery periods. The clinical investigation revealed an unusually high percentage of carpal tunnel syndromes, often associated with Guyon channel syndrome. This disorder affects males and females equally, is often bilateral, and is not associated with known non-occupational factors. The widespread outbreak of work-related musculo-skeletal disorders reported in the departments in question may have arisen from a combination of significant risk factors relating to the types of activities performed, and the long service of the workers. It is reasonable to assume that failure to adopt technical preventive and organisational measures may have stemmed primarily from a poor evaluation of the relevant occupational risks, and from many years of substandard health surveillance practices.

Adult↗