Background:Total hip replacement (THR) is often accompanied by severe postoperative pain. We aimed to study whether oxycodone can be an effective alternative for fentanyl in the management of early postoperative pain after total hip replacement.Methods:We conducted a randomized controlled trial on 46 patients scheduled to undergo THR. We followed a standard general anesthetic technique, with endotracheal intubation. Twenty minutes before the end of surgery, single bolus injection of fentanyl, 50 μg (fentanyl group [group F], n = 23) or oxycodone, 4 mg (oxycodone group [group O], n = 23) was administered intravenously. Numeric rating scale (NRS) was used to assess pain in the post-anesthesia care unit (PACU). All patients had intravenous patient-controlled analgesia (PCA) with 10 μg/kg of fentanyl for 48 hours. Intravenous boluses of 50 μg were administered for breakthrough pain. The cumulative opioid dose administered at 6, 12, 24, and 48 h after surgery were recorded. A P value of less than .05 was considered statistically significant.Results:The NRS of group O in the PACU was significantly lower (P <.05); fewer patients in group O required additional fentanyl boluses in the PACU (P <.05). The cumulative opioid requirement was significantly less in group O at 6, 12, 24, and 48 hours after surgery. (P <.05)Conclusions:A single bolus injection of oxycodone is more effective than that of fentanyl in the acute phase of postoperative pain after THR. It may be used as an alternative drug for fentanyl in pain control after orthopedic surgery.
Extracorporeal membrane oxygenation for takotsubo cardiomyopathy that developed after mitral valve replacement Takotsubo cardiomyopathy is a transient systolic and diastolic left ventricular dysfunction that presents several wall-motion abnormalities, while the coronary artery shows normal findings. Because patients with Takotsubo cardiomyopathy present with symptoms similar to acute coronary syndrome, the initial diagnosis and treatment are often difficult. The condition is often precipitated by acute emotional or physical stress and frequently occurs in postmenopausal women. Takotsubo cardiomyopathy may also occur in the perioperative period after cardiac and noncardiac surgery; surgery-associated Takotsubo cardiomyopathy reportedly accounts for 3%-23% of all cases. Of these perioperative cases, cardiothoracic surgery accounted for 16%. However, few cases have been reported in patients undergoing cardiac surgery and managed with extracorporeal membrane oxygenation (ECMO). We report a case of Takotsubo cardiomyopathy managed with ECMO in a patient in the intensive care unit after mitral valve replacement.
Background Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery. Case Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance. Conclusions We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.
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