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T Callesen

Publications and source records attributed to T Callesen.

27 records · Page 2Linked to original sources
PubMed1996

Postoperative opioid analgesia: time for a reconsideration?

Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly better analgesic effects, and also fewer unwanted side effects. Although opioids have played a prominent role in postoperative analgesia for centuries and are still often administered as a matter of routine, their frequent minor side effects and the increasing availability of suitable alternatives may limit their future use in some situations. Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing of analgesics and/or a reasonably large patient sample size. These data do not allow a proper meta-analysis to be performed because of the large variability in surgical procedures, dosing regimens, assessment criteria, among others.

Analgesics, Opioid↗
PubMed1996

Analgesic and anti-inflammatory effects of lignocaine-prilocaine (EMLA) cream in human burn injury.

Pain relief may be improved by reducing sensitization of nociceptive pathways caused by tissue injury. Such a reduction depends mainly on inhibition of local inflammatory changes and the relation between duration of nociceptive block and nociceptive input. In this study we examined if prolonged topical treatment with local anaesthetics could reduce late hyperalgesia and local inflammation after burn injury in healthy volunteers. The effects of EMLA treatment for 8 h after burn on hyperalgesia, inflammation and wound healing were compared with the contralateral placebo-treated leg for 48 h after bilateral burn injuries (15 x 25 mm, 49 degrees C for 5 min) in a double-blind, randomized study in 12 healthy volunteers. Wound healing was studied 1 and 2 weeks after injury. Neither mechanical nor thermal primary hyperalgesia were affected significantly by prolonged EMLA treatment. Secondary hyperalgesia and skin erythema were also not changed. Seven of 12 placebo-treated legs developed blisters, in contrast with four of 12 EMLA-treated legs. Wound healing showed no apparent differences. Our data suggest that prolonged, topical treatment with local anaesthetics did not reduce local inflammation and late hyperalgesia.

Adult↗
PubMed1995

[Inguinal herniotomy--which kind of anesthesia? Economical considerations].

Economical aspects of three different types of anaesthesia for inguinal hernia repair are discussed on the basis of relevant papers and economical estimates. Infiltration anaesthesia is found to be less expensive than both spinal and general anaesthesia. The reduction in cost is mainly based on a reduced demand for observation facilities during and after the operation as well as for preoperative evaluation. Early postoperative analgesia is improved after inguinal field block. Urinary retention is seen with a reduced frequency after inguinal field block. The risk of wound complication seems unrelated to the type of anaesthesia. The risk of serious complications related to anaesthesia (i.e. aspiration pneumonitis and significant circulatory events) is probably lower after infiltration anaesthesia. It is recommended that infiltration anaesthesia be employed for hernia repair.

Anesthesia, General↗
PubMed1993

[Bupivacaine in spinal anesthesia. The spread of analgesia--dependence on baricity, positioning, dosage, technique of injection and patient characteristics].

The spread of sensory blockade during spinal analgesia using bupivacaine is influenced by a number of factors concerning baricity, positioning, dosage, technique of injection and patient characteristics. The glucose-free 0.5%-solution acts as a hypobaric solution. The interaction of baricity and posture during and immediately after the injection of this solution is of utmost importance. However, the level of analgesia when using hyperbaric solutions seems not to be affected by posture. The dose of bupivacaine is also of great importance, independent of the type of solution used. Of modest importance is patient age, irrespective of baricity, while obesity and injection level only matter when the glucose-free solution is used. Injection speed seems of modest importance, while barbotage and direction of the needle have no or minimal clinical importance. The problem of unpredictability of the sensory blockade, a major one in spinal analgesia, is yet to be solved.

Age Factors↗
PubMed1993

[Hemodynamic aspects of thoracic epidural analgesia].

Twenty-seven experimental and clinical studies on hemodynamic changes during thoracic epidural analgesia (TEA) are reviewed. It is concluded, that TEA exerts negative chronotropic, inotropic, dromotropic and bathmotropic effects on the heart. The systemic vascular resistance as well as cardiac output are diminished, and a substantial reduction in the myocardial oxygen consumption is also seen. Under close monitoring of the cardiovascular status, TEA seems suitable for surgery in patients with ischemic heart disease. Furthermore, the use of TEA with moderate dosage of the local analgesic agent could be a supplement in the treatment of severe angina pectoris.

Analgesia, Epidural↗
PubMed1991

Influence of temperature of bupivacaine on spread of spinal analgesia.

A prospective, randomised study was performed to investigate the influence of temperature on sensory blockade in spinal anaesthesia. Three ml of plain bupivacaine 0.5% were injected intrathecally at either 4 degrees C, room temperature, or 37 degrees C. There were 10 patients in each group, who were kept sitting for 2 minutes after injection. The maximum level of sensory blockade was significantly higher (p less than 0.01) in the group who received the solution adjusted to 37 degrees C, and variability of level was smaller (p less than 0.05). Time to two-segment regression was shorter in the 37 degrees C group than in the 4 degrees C group (p less than 0.05). Hypotension required administration of ephedrine more often in the 37 degrees C group (p less than 0.05). It is concluded that the use of plain bupivacaine 0.5% adjusted to 37 degrees C results in a higher and more predictable sensory blockade.

Aged↗
PubMedDate not supplied

Level of injection in spinal anesthesia: effect on sensory anesthetic level.

BACKGROUND AND OBJECTIVES: A prospective, randomized study was performed to investigate the influence of the level of injection on sensory anesthesia when bupivacaine 0.5% adjusted to 37.0 C was used. METHODS: Three milliliters of plain bupivacaine 0.5% were injected at either the L2-3 interspace or the L4-5 interspace. There were 10 patients in each group. The patients were kept sitting for 2 minutes after injection. RESULTS: No significant difference in maximal level of sensory anesthesia was found (p = 0.123). CONCLUSION: These preliminary results indicate that if a higher level of injection is more suitable for anatomic reasons, it can safely be used without the risk of a much higher level of sensory blockade.

Aged↗