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Background and Goal of StudyPerineural dexamethasone has gained popularity in regional anaesthesia to prolong analgesia duration, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve blockade.Materials and MethodsThe methodology followed the PRISMA statement guidelines. The primary outcome was duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in intravenous morphine equivalents, pain scores and complications rates (neurologic complication, infection, hyperglycaemia).Results and DiscussionEleven controlled trials, including 914 patients, were identified. Duration of analgesia was significantly increased with perineural dexamethasone versus systemic dexamethasone by a mean difference of 3h (95%CI: 1.4, 4.5 h; p=0.0001). Subgroup analysis reveals that the duration of analgesia was increased by 21% with bupivacaine (mean difference: 4.0 hours; 95%CI: 2.8, 5.2 hours; p

Background and Goal of StudyPerineural dexamethasone has gained popularity in regional anaesthesia to prolong analgesia duration, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve blockade.Materials and MethodsThe methodology followed the PRISMA statement guidelines. The primary outcome was duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in intravenous morphine equivalents, pain scores and complications rates (neurologic complication, infection, hyperglycaemia).Results and DiscussionEleven controlled trials, including 914 patients, were identified. Duration of analgesia was significantly increased with perineural dexamethasone versus systemic dexamethasone by a mean difference of 3h (95%CI: 1.4, 4.5 h; p=0.0001). Subgroup analysis reveals that the duration of analgesia was increased by 21% with bupivacaine (mean difference: 4.0 hours; 95%CI: 2.8, 5.2 hours; p

Background and Goal of StudyRate of postoperative nausea and vomiting varies between 40 and 75% in children. Dexamethasone, ondansetron and droperidol are effective antiemetic drugs that have never been investigated when administered in combination. This randomized, double-blind trial tested the hypothesis that the combination of dexamethasone with droperidol is as effective as the combination of dexamethasone with ondansetron for the prophylaxis of nausea and vomiting after pediatric tonsillectomy.Materials and MethodsThree hundred children scheduled for bilateral tonsillectomy with or without adenoidectomy were randomized into three groups according to an intravenous regimen administered after induction of anaesthesia: Group D received dexamethasone (250 mcg/kg); Group DD received dexamethasone (250 mcg/kg) and droperidol (10 mcg/kg); Group DO received dexamethasone (250 mcg/kg) and ondansetron (150 mcg/kg). The primary outcome was the rate of postoperative nausea and vomiting on postanaesthetic care unit. Secondary outcomes included rates of side effects such as hemorrhage, extrapyramidal syndrome or somnolence.ResultsThe rate of postoperative nausea and vomiting on postanaesthetic care unit was significantly reduced in Group DO (Group D = 44%, Group DD = 36%, Group DO = 9%; p

Background and Goal of StudyMany authors consider blockade of the femoral nerve distribution the gold standard analgesic treatment after anterior cruciate ligament reconstruction. However, some argue an alternative approach of local infiltration analgesia, using local anesthetics injection into the surgical site, has similar efficacy. The objectives of this meta-analysis were to compare the analgesia and functional outcomes of both treatments following anterior ligament reconstruction.Materials and MethodsThe methodology followed the PRISMA statement guidelines. The primary outcomes were pain scores at rest (analogue scale, 0-10) in the early (0-2 postoperative hours), intermediate (3-12 postoperative hours), and late postoperative periods (13-24 postoperative hours). Secondary outcomes included range of motion, quadriceps muscle strength, and complication rates (neurologic events, cardiovascular events, falls, knee infections, or knee chondrolysis).Results and DiscussionTen trials, including 588 patients, were identified. Pain scores in the early (mean difference: 1.6; 95%CI: 0.2, 2.9mg; I2=97%; p=0.02), intermediate (mean difference: 1.2; 95%CI: 0.4, 1.5; I2=85%; p=0.002) and late (mean difference: 0.7; 95%CI: 0.1, 1.4; I2=82%; p=0.03) postoperative periods were significantly lower in patients who received a femoral nerve block (table 1). The quality of evidence for our primary outcomes were moderate to high according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group System. Regarding the functional outcomes, only one trial reported range of motion at 48 postoperative hours, which was found to be similar between groups (mean difference: -5u00b0; 95%CI: -14, 4u00b0; p = 0.27). No trials sought to record side-effects such as neurologic events, cardiovascular events, falls, knee infections, or knee chondrolysis.ConclusionFemoral nerve block provides superior postoperative analgesia after anterior cruciate ligament reconstruction when compared to local infiltration analgesia. The impact of improved analgesia on function remains unanswered due to the lack of functional outcomes reported in existing literature.

Background: ln Switzerland no HIV test is performed without the patient's consent based on a Voluntary Counseling and Testing policy (VCT). We hypothesized that a substantial proportion of patients going through an elective surgery falsely believed that an HIV test was performed on a routine basis and that the lack of transmission of result was interpreted as being HIV negative. Method: All patients with elective orthopedic surgery during 2007 were contacted by phone in 2008. A structured questionnaire assessed their belief about routine preoperative blood analysis (diabetes, coagulation function, HIV test and cholesterol level) as well as result awareness and interpretation. Variables included age and gender. Analysis were conducted using the software JMP 6.0.3. Results: 1123 patients were included. 130 (12 %) were excluded (Le. unreachable, unable to communicate on the phone, not operated). 993 completed the survey (89 %). Median age was 51 (16-79). 50 % were female. 376 (38 %) patients thought they had an HIV test performed before surgery but none of them had one. 298 (79 %) interpreted the absence of result as a negative HIV test. A predictive factor to believe an HIV test had been done was an age below 50 years old (45 % vs 33 % for 16-49 years old and 50-79 years old respectively, p < 0.001). No difference was observed between genders. Conclusion: ln Switzerland, nearly 40 % of the patients falsely thought an HIV test had been performed on a routine basis before surgery and were erroneously reassured about their HIV status. These results should either improve the information given to the patient regarding preoperative exams, or motivate public health policy to consider HIV opt-out screening instead of VCT strategy.

Includes abstract. Includes bibliographical references (leaves 33-36).

Background and aim of the study: Formation of implicit memory during general anaesthesia is still debated. Perceptual learning is the ability to learn to perceive. In this study, an auditory perceptual learning paradigm, using frequency discrimination, was performed to investigate the implicit memory. It was hypothesized that auditory stimulation would successfully induce perceptual learning. Thus, initial thresholds of the frequency discrimination postoperative task should be lower for the stimulated group (group S) compared to the control group (group C). Material and method: Eighty-seven patients ASA I-III undergoing visceral and orthopaedic surgery during general anaesthesia lasting more than 60 minutes were recruited. The anaesthesia procedure was standardized (BISR monitoring included). Group S received auditory stimulation (2000 pure tones applied for 45 minutes) during the surgery. Twenty-four hours after the operation, both groups performed ten blocks of the frequency discrimination task. Mean of the thresholds for the first three blocks (T1) were compared between groups. Results: Mean age and BIS value of group S and group C are respectively 40 } 11 vs 42 } 11 years (p = 0,49) and 42 } 6 vs 41 } 8 (p = 0.87). T1 is respectively 31 } 33 vs 28 } 34 (p = 0.72) in group S and C. Conclusion: In our study, no implicit memory during general anaesthesia was demonstrated. This may be explained by a modulation of the auditory evoked potentials caused by the anaesthesia, or by an insufficient longer time of repetitive stimulation to induce perceptual learning.