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N M Denny

Publications and source records attributed to N M Denny.

15 recordsLinked to original sources
PubMed2006

Postoperative shoulder surgery initiative (POSSI): an interim report of major shoulder surgery as a day case procedure.

BACKGROUND: There are logistical and financial advantages to undertaking shoulder surgery in a day case setting. However, this approach is limited by postoperative pain being inadequately controlled by oral medication alone. We describe a pilot study investigating the feasibility and acceptance of community based continuous interscalene brachial plexus blockade (CIBPB) to provide effective analgesia for day case shoulder surgery. METHODS: Phase 1 consisted of five patients who received CIBPB for shoulder surgery. Following an overnight hospital stay they were assessed for discharge home with the interscalene catheter in situ. Once the safety and feasibility of the approach was documented, five more patients were recruited to Phase 2. These patients had the adequacy of analgesia assessed in the postoperative period and were discharged home on the same day as surgery. A district nurse visited twice daily and removed the catheter on the third day. Patient satisfaction was assessed using a discovery interview. RESULTS: Nine of the 10 patients experienced good analgesia. One patient was re-admitted because the catheter fell out. No patient experienced complications and the discovery interviews showed that the patients were satisfied with their management and pleased to be treated as a day case. CONCLUSIONS: POSSI proved that it was feasible to manage these patients in the community with support and training of the district nurses. Although extra community nursing hours are required, this technique has the potential for significant cost benefits with at least three bed days saved per patient.

Adult↗
PubMed2003

Evaluation of an insulated Tuohy needle system for the placement of interscalene brachial plexus catheters.

Major shoulder surgery can be extremely painful. Interscalene brachial plexus catheters provide excellent postoperative analgesia but are technically difficult to place. A new insulated Tuohy needle system for plexus catheterisation is now available. This prospective study examined its ease of use and the postoperative analgesia produced by patient-controlled interscalene analgesia with ropivacaine 0.2%. Nineteen patients undergoing major shoulder surgery were studied. Interscalene brachial plexus blocks were performed using a modified Winnie technique with the insulated Tuohy needle and a nerve stimulator. After injection of ropivacaine 0.75% 30-40 ml into the plexus, a catheter was inserted. Block and catheter insertion times were recorded. All 19 patients had successful blocks and had catheters successfully threaded. Catheter infusions provided successful analgesia (visual analogue pain score < 5/10) in 18 patients, with one failure, giving a 95% success rate. Mean [range] catheter insertion time was 3.6 [1-10] min. Decreased block and catheter insertion times were associated with experience with the equipment when comparing the mean (SD) times for the first seven catheters and the last seven catheters inserted (12.1 (4.2) min vs. 7.9 (2.4) min), p < 0.05). It is concluded that the insulated Tuohy needle system for interscalene catheterisation proved easy to use in the hands of someone who had not used it before, and can be recommended.

Adult↗
PubMed1996

The laryngeal mask airway for thyroid and parathyroid surgery.

The rôle of the laryngeal mask airway for thyroid and parathyroid surgery was studied in 97 consecutive patients. In 50% the technique combined electrical stimulation of the recurrent laryngeal nerve with visualisation of vocal cord movement via a fibreoptic bronchoscope. Stimulation was required in 10% to assist in identifying recurrent laryngeal nerve position during difficult surgical dissection. In the remaining 40% stimulation was used to confirm nerve integrity and for teaching purposes. Tracheal intubation was required for seven patients but in only two of these was intubation unplanned. The incidence of postoperative recurrent laryngeal nerve dysfunction was zero. These data suggest that the technique offers a safe alternative in airway management and may provide advantages in terms of preservation of recurrent laryngeal nerve function.

Electric Stimulation↗
PubMed1993

Complications following general anaesthesia for cataract surgery: a comparison of the laryngeal mask airway with tracheal intubation.

The incidence of airway complications following general anaesthesia using either a tracheal tube or a laryngeal mask airway was compared in a prospective, randomized study of 79 patients undergoing elective cataract surgery using a standard anaesthetic technique. Assessment was made both at extubation (which was taken to include removal of the laryngeal mask airway) and for 25 min afterwards. There was a significantly greater incidence of coughing prior to extubation (P < 0.001), at extubation (P < 0.001) and after extubation (P < 0.001) in the tracheal group than in the laryngeal mask airway group. No other airway complications were seen in either group.

Aged↗
PubMed1986

Vecuronium and atracurium infusions during hypothermic cardiopulmonary bypass.

Two similar groups of patients undergoing coronary artery bypass grafting received either atracurium or vecuronium infusions for neuromuscular blockade. Both groups demonstrated a marked reduction in neuromuscular blocking requirements during hypothermic bypass at 30 C. The ratio of the dose rates at 30 C to that at 37 C was significantly less with vecuronium (p less than 0.01).

Atracurium↗
PubMedDate not supplied

Initial experience of continuous subarachnoid diamorphine infusion for postoperative pain relief.

The quality of analgesia and incidence of side effects when using a continuous subarachnoid infusion of diamorphine were assessed in 28 postoperative patients who had undergone major abdominal or lower limb surgery. Excellent pain relief was obtained without depression of the respiratory rate. Four patients complained of headache, and 50% of those patients not already catheterized preoperatively subsequently required it for urinary retention. There was no evidence of sepsis related to the indwelling subarachnoid catheter.

Adult↗
PubMedDate not supplied

Postoperative analgesia following total knee arthroplasty: a study comparing spinal anesthesia and combined sciatic femoral 3-in-1 block.

BACKGROUND AND OBJECTIVES: The quality of analgesia and subsequent morphine requirements following spinal anesthetic block (SAB) or combined sciatic and femoral (3-in-1) block (SFB) for total knee arthroplasty were compared. METHODS: The 39 patients studied were randomly assigned to receive either SAB (n = 19) or SFB (n = 20). All patients received a standardized general anesthetic, patient-controlled analgesia, and regular diclofenac. Visual analog pain scores and morphine requirements were recorded for 48 hours following surgery. Observations were grouped into four 12-hour periods. Pain scores (0-10 cm) were expressed as 95% confidence intervals; the criterion for analgesic success was a confidence interval in the range 0-3 cm. RESULTS: Although pain-free on awakening, the SAB patients failed to achieve analgesic success in any of the four periods, while the SFB patients did so in three of the four periods. Morphine consumption was significantly higher in the SAB group during the first two periods but similar to the SFB group thereafter. CONCLUSION: In comparison with SAB, SFB resulted in superior analgesia and reduced morphine consumption for the first 24 hours following total knee arthroplasty.

Aged↗