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  • 1.
    Axelsson, Birger
    et al.
    Department of Cardiovascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Häggmark, Sören
    Department of Surgical and Perioperative Sciences, Heart Centre and Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden.
    Svenmarker, Staffan
    Department of Surgical and Perioperative Sciences, Heart Centre and Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden.
    Johansson, Göran
    Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden .
    Gupta, Anil
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, Örebro University Hospital, Örebro, Sweden.
    Tydén, Hans
    Örebro University, School of Health Sciences. Department of Cardiovascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, Örebro University Hospital, Örebro, Sweden.
    Wouters, Patrick
    Department of Anesthesiology, University Hospital Ghent, Ghent, Belgium.
    Haney, Michael
    Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden .
    Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model2016In: Journal of Cardiovascular Pharmacology and Therapeutics, ISSN 1074-2484, E-ISSN 1940-4034, Vol. 21, no 5, p. 495-503Article in journal (Refereed)
    Abstract [en]

    It is not known whether there are positive or negative interactions on ventricular function when a calcium-sensitizing inotrope is added to a phosphodiesterase inhibitor in the clinical setting of acute left ventricular (LV) dysfunction. We hypothesized that when levosimendan is added to milrinone treatment, there will be synergetic inotropic and lusitropic effects. This was tested in an anesthetized porcine postischemic global LV injury model, where ventricular pressures and volumes (conductance volumetry) were measured. A global ischemic injury was induced by repetitive left main stem coronary artery occlusions. Load-independent indices of LV function were assessed before and after ventricular injury, after milrinone treatment, and finally after addition of levosimendan to the milrinone treatment. Nonparametric, within-group comparisons were made. The protocol was completed in 12 pigs, 7 of which received the inotrope treatment and 5 of which served as controls. Milrinone led to positive lusitropic effects seen by improvement in tau after myocardial stunning. The addition of levosimendan to milrinone further increased lusitropic state. The latter effect could however not be attributed solely to levosimendan, since lusitropic state also improved spontaneously in time-matched controls at the same rate during the corresponding period. When levosimendan was added to milrinone infusion, there was no increase in systolic function (preload recruitable stroke work) compared to milrinone treatment alone. We conclude that in this model of postischemic LV dysfunction, there appears to be no clear improvement in systolic or diastolic function after addition of levosimendan to established milrinone treatment but also no negative effects of levosimendan in this context.

  • 2.
    Axelsson, Birger
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    Johansson, G.
    Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden.
    Abrahamsson, P.
    Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden.
    Gupta, Anil
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tyden, H.
    Anaesthesia and Intensive Care, Department of Cardiovascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Wouters, P.
    Department of Anesthesiology, University Hospital Ghent, Ghent, Belgium.
    Haney, M.
    Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden.
    Milrinone and levosimendan during porcine myocardial ischemia: no effects on calcium overload and metabolism2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 6, p. 719-728Article in journal (Refereed)
    Abstract [en]

    Background: Although inotropic stimulation is considered harmful in the presence of myocardial ischaemia, both calcium sensitisers and phosphodiesterase inhibitors may offer cardioprotection. We hypothesise that these cardioprotective effects are related to an acute alteration of myocardial metabolism. We studied in vivo effects of milrinone and levosimendan on calcium overload and ischaemic markers using left ventricular microdialysis in pigs with acute myocardial ischaemia.

    Methods: Anaesthetised juvenile pigs, average weight 36kg, were randomised to one of three intravenous treatment groups: milrinone 50g/kg bolus plus infusion 0.5g/kg/min (n=7), levosimendan 24g/kg plus infusion 0.2g/kg/min (n=7), or placebo (n=6) for 60min prior to and during a 45min acute regional coronary occlusion. Systemic and myocardial haemodynamics were assessed, and microdialysis was performed with catheters positioned in the left ventricular wall. 45Ca2+ was included in the microperfusate in order to assess local calcium uptake into myocardial cells. The microdialysate was analysed for glucose, lactate, pyruvate, glycerol, and for 45Ca2+ recovery.

    Results: During ischaemia, there were no differences in microdialysate-measured parameters between control animals and milrinone- or levosimendan-treated groups. In the pre-ischaemic period, arterial blood pressure decreased in all groups while myocardial oxygen consumption remained stable.

    Conclusions: These findings reject the hypothesis of an immediate energy-conserving effect of milrinone and levosimendan during acute myocardial ischaemia. On the other hand, the data show that inotropic support with milrinone and levosimendan does not worsen the metabolic parameters that were measured in the ischaemic myocardium.

  • 3.
    Axelsson, Kjell
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences.
    Johanzon, Eva
    Berg, Elisabeth
    Ekbäck, Gustav
    Rawal, Narinder
    Enström, Peter
    Nordensson, Ulf
    Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study2008In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 106, no 1, p. 328-333Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In this study we assessed the efficacy of intraarticular regional analgesia on postoperative pain and analgesic requirements. METHODS: Fifty-one patients undergoing shoulder surgery (Bankart) were recruited into this double-blind study. At the end of the operation, patients were randomized to three groups to receive intraarticularly via a catheter: Group 1: ropivacaine 90 mg (9 mL), morphine 4 mg (10 mL), and ketorolac 30 mg (1 mL) (total volume 20 mL); Groups 2 and 3: saline (20 mL). In addition, Groups 1 and 3 received 1 mL saline IV while Group 2 received ketorolac 30 mg (1 mL) IV. Postoperatively, Group 1 received pain relief using 10 mL 0.5% ropivacaine on demand via the intraarticular catheter while Groups 2 and 3 received 10 mL of saline intraarticularly. Group 3 was the Control group. RESULTS: Postoperative pain at rest and on movement were lower in Group 1 than in Groups 2 and 3 during the first 30 and 120 min, respectively. The time to first request for local anesthetic infusion was longer in Group 1 than in Groups 2 and 3 (P < 0.001). The median morphine consumption during the first 24 postoperative hours was less in Groups 1 and 2 than in Group 3 (P < 0.001). There was no significant difference in analgesic consumption between Group 1 and Group 2. The median satisfaction score was higher in Group 1 compared with Groups 2 (P < 0.05) and 3 (P < 0.001). CONCLUSIONS: A combination of intraarticular ropivacaine, morphine, and ketorolac followed by intermittent injections of ropivacaine as needed provided better pain relief, less morphine consumption, and improved patient satisfaction compared with the control group. The group that received IV ketorolac consumed less morphine and was more satisfied with treatment than patients in the control group.

  • 4.
    Bastami, Salumeh
    et al.
    Unit for Development and Patient Safety, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesia and Intensive Care, Örebro University, Örebro, Sweden.
    Zackrisson, Anna-Lena
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Ahlner, Johan
    Unit for Development and Patient Safety, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden .
    Osman, Abdimajid
    Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Uppugunduri, Srinivas
    Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Influence of UGT2B7, OPRM1 and ABCB1 Gene Polymorphisms on Postoperative Morphine Consumption2014In: Basic & Clinical Pharmacology & Toxicology, ISSN 1742-7835, E-ISSN 1742-7843, Vol. 115, no 5, p. 423-431Article in journal (Refereed)
    Abstract [en]

    Therapeutic modulation of pain with morphine and other opioids is associated with significant variation in both effects and adverse effects in individual patients. Many factors including gene polymorphisms have been shown to contribute to the interindividual variability in the response to opioids. The aim of this study was to investigate the significance of UGT2B7,OPRM1 and ABCB1 polymorphisms for interindividual variability in morphine-induced analgesia in patients undergoing hysterectomy. The frequency of these polymorphisms was also investigated in forensic autopsies as morphine is also a very commonly abused drug. Blood samples were collected from 40 patients following abdominal hysterectomy, 24hr after initiation of analgesia through a patient-controlled analgesia (PCA) pump. Samples were genotyped and analysed for morphine and its metabolites. We also genotyped approximately 200 autopsies found positive for morphine in routine forensic analysis. Patients homozygous for UGT2B7 802C needed significantly lower dose of morphine for pain relief. The same trend was observed for patients homozygous for ABCB1 1236T and 3435T, as well as to OPRM1 118A. The dose of morphine in patients included in this study was significantly related to variation in UGT2B7 T802C. Age was significantly related to both dose and concentration of morphine in blood. Regression analysis showed that 30% of differences in variation in morphine dose could be explained by SNPs in these genes. The genotype distribution was similar between the forensic cases and the patients. However, the mean concentration of morphine was higher in forensic cases compared to patients. We conclude that gene polymorphisms contribute significantly to the variation in morphine concentrations observed in individual patients.

  • 5.
    Darvish, Bijan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Dahlgren, G.
    Department of Anesthesia and Intensive Care, Capio St Görans Hospital, Stockholm, Sweden.
    Irestedt, L.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Magnuson, A.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Swedish Institute of Disability Research, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Auditory function following post-dural puncture headache treated with epidural blood patch: a long-term follow-up2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1340-1354Article in journal (Refereed)
    Abstract [en]

    Background: Epidural analgesia is commonly used for pain management during labor. Sometimes, accidental dural puncture (ADP) occurs causing severely debilitating headache, which may be associated with transient hearing loss. We investigated if auditory function may be impaired several years after ADP treated with epidural blood patch (EBP).

    Methods: Sixty women (ADP group) without documented hearing disability, who received EBP following ADP during labor between the years 2005-2011 were investigated in 2013 for auditory function using the following tests: otoscopic examination, tympanometry, pure tone audiometry, and transient-evoked otoacoustic emissions. Additionally, they responded to a questionnaire, the Speech, Spatial and Qualities (SSQ) of hearing, concerning perceived hearing impairment. The results were compared to a control group of 20 healthy, non-pregnant women in the same age group.

    Results: The audiometric test battery was performed 5.2 (1.9)years after delivery. No significant differences were found between the ADP and the control groups in tympanometry or otoacoustic emissions. Pure tone audiometry revealed a significant but small (<5dB) difference between the ADP and control groups (P<0.05). The ability to hear speech in noise as measured by SSQ was significantly reduced in the ADP group compared to the control group (P<0.05).

    Conclusions: A minor hearing loss was detected in the ADP group compared to the control group in pure tone audiometry in some women and during speech-in-noise component several years after accidental dural puncture treated with an epidural blood patch. This small residual hearing loss has minor clinical significance.

  • 6.
    Darvish, Bijan
    et al.
    Karolinska University Hospital Solna, Stockholm, Sweden.
    Dahlgren, Gunnar
    Capio St Görans Hospital, Stockholm, Sweden.
    Irestedt, Lars
    Karolinska University Hospital, Solna, Sweden.
    Magnuson, Anders
    Örebro university, Örebro, Sweden.
    Möller, Claes
    School Medicine & Health Sci, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Karolinska University Hospital Solna, Stockholm, Sweden.
    Auditory function following post dural puncture headache treated with epidural blood patch A long-term follow-up of parturients2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, p. 24-25Article in journal (Other academic)
  • 7.
    Essving, Per
    et al.
    Örebro University, School of Health and Medical Sciences.
    Axelsson, Kjell
    Kjellberg, Jill
    Wallgren, Örjan
    Gupta, Anil
    Lundin, Anders
    Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty: a randomized double-blind study of 40 patients2009In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 80, no 2, p. 213-219Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: The degree of postoperative pain is usually moderate to severe following knee arthroplasty. We investigated the efficacy of local administration of analgesics into the operating area, both intraoperatively and postoperatively. METHODS: 40 patients undergoing unicompartmental knee arthroplasty (UKA) were randomized into 2 groups in a double-blind study (ClinicalTrials.gov identifier: NCT00653926). In group A (active), 200 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 106 mL) were infiltrated intraoperatively into the soft tissue, while in group P (placebo), no injections were given. 21 hours postoperatively, 150 mg ropivacain, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly via a catheter in group A, whereas patients in group P were injected with the same volume of saline (22 mL). RESULTS: Median hospital stay was shorter in group A than in group P: 1 (1-6) days as opposed to 3 (1-6) days (p < 0.001). Postoperative pain in group A was statistically significantly lower at rest after 6 h and 27 h and on movement after 6, 12, 22, and 27 h. Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation. Postoperatively, there were improved functional scores (Oxford knee score and EQ-5D) in both groups relative to the corresponding preoperative values. INTERPRETATION: Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA. There was a high degree of patient satisfaction in both groups after 6 months (Clinical Trials.gov: NCT 00653926).

  • 8.
    Essving, Per
    et al.
    Örebro University, School of Health and Medical Sciences.
    Axelsson, Kjell
    Kjellberg, Jill
    Wallgren, Örjan
    Gupta, Anil
    Lundin, Anders
    Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty: a randomized double-blind study involving 48 patients2010In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, no 3, p. 354-360Article in journal (Refereed)
    Abstract [en]

    Background and purpose:  Postoperative pain is often severe following total knee arthroplasty (TKA). We investigated the efficacy of local infiltration analgesia (LIA) technique, intra- and postoperatively.

    Methods:  48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac and 0.5 mg epinephrine were infiltrated periarticularly intra-operatively. In group P, no injections were given. At 21 hours postoperatively, 200 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. Patients were followed up for 3 months.

    Results:  Median morphine consumption was lower in group A during 0-48 h: 18 (1-74) mg vs. 87 (36-160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfilling discharge criteria was shorter in group A than in group P; 3 (1-7) vs. 5 (2-8) days. Patient satisfaction was higher in group A compared to group P on day 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations.

     

    Interpretation:  Local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. Side effects were few and systemic LA concentrations low.

  • 9.
    Essving, Per
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopedic Surgery, University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, Örebro University, University Hospital, Örebro, Sweden.
    Otterborg, Lena
    Department of Orthopedic Surgery, Örebro University, University Hospital, Örebro, Sweden.
    Spännar, Henrik
    Department of Physiotherapy, Örebro University, University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Örebro University, University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Department of Clinical Epidemiology and Biostatistics, Örebro University, University Hospital, Örebro, Sweden.
    Lundin, Anders
    Department of Orthopedic Surgery, Örebro University, University Hospital, Örebro, Sweden.
    Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia A randomized controlled trial with 40 patients2012In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 83, no 6, p. 634-641Article in journal (Refereed)
    Abstract [en]

    Background and purpose: There has recently been interest in the advantages of minimally invasive surgery (MIS) over conventional surgery, and on local infiltration analgesia (LIA) during knee arthroplasty. In this randomized controlled trial, we investigated whether MIS would result in earlier home-readiness and reduced postoperative pain compared to conventional unicompartmental knee arthroplasty (UKA) where both groups received LIA.

    Patients and methods: 40 patients scheduled for UKA were randomized to a MIS group or a conventional surgery (CON) group. Both groups received LIA with a mixture of ropivacaine, ketorolac, and epinephrine given intra-and postoperatively. The primary endpoint was home-readiness (time to fulfillment of discharge criteria). The patients were followed for 6 months.

    Results: We found no statistically significant difference in home-readiness between the MIS group (median (range) 24 (21-71) hours) and the CON group (24 (21-46) hours). No statistically significant differences between the groups were found in the secondary endpoints pain intensity, morphine consumption, knee function, hospital stay, patient satisfaction, Oxford knee score, and EQ-5D. The side effects were also similar in the two groups, except for a higher incidence of nausea on the second postoperative day in the MIS group.

    Interpretation: Minimally invasive surgery did not improve outcome after unicompartmental knee arthroplasty compared to conventional surgery, when both groups received local infiltration analgesia. The surgical approach (MIS or conventional surgery) should be selected according to the surgeon's preferences and local hospital policies.

  • 10.
    Essving, Per
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Division of Clinical Medicine, Örebro University Hospital, Örebro, Sweden; Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Åberg, Elisabeth
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Spännar, Henrik
    Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; University of Linköping, Linköping, Sweden.
    Lundin, Anders
    Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden; Division of Clinical Medicine, Örebro University Hospital, Örebro, Sweden.
    Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial2011In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 113, no 4, p. 926-933Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Local infiltration analgesia (LIA) using a combination of local anesthetics, non-steroidal anti-inflammatory drugs and epinephrine, injected periarticularly during surgery has become popular in postoperative pain management following total knee arthroplasty (TKA). This study compared intrathecal morphine with LIA following TKA.

    METHODS:  In this double-blind study, 50 patients scheduled to undergo TKA under spinal anesthesia were randomized into two groups: Group M: 0.1 mg morphine was injected intrathecally together with the spinal anesthetic and Group L: LIA using ropivacaine, ketorolac and epinephrine was infiltrated in the knee during the operation and two bolus injections of the same mixture were given via an intraarticular catheter postoperatively. Postoperative pain, rescue analgesic requirements, mobilization and home readiness were recorded. Patient-assessed health quality was recorded using the Oxford Knee Score and EQ-5D during three months follow-up. Primary endpoint was IV morphine consumption the first 48 postoperative hours.

    RESULTS: Mean morphine consumption was significantly lower in group L compared to group M during the first 48 postoperative hours: 27 ± 18 vs. 54 ± 30 mg, i.e. a mean difference for each 24-hour-period of 14,2 (CI 95 % 7.6-20.9) mg. Pain scores at rest and on movement were lower during the first 48 h in group L compared to group M (P < 0.001). Pain score was also lower on walking in group L compared to group M at 24 h and 48 h postoperatively (P < 0.01). In group L more patients were able to climb stairs at 24 h: 50 % (11/22) vs. 4 % (1/23), i.e. a difference of 46 % (CI 95 % 23.5-68.5) and at 48 h: 70 % (16/23) vs. 22 % (5/23), i.e. a difference of 48 % (CI 95 % 23-73). Median (range) time to fulfillment of discharge criteria was shorter in group L compared to group M, 51 (24-166) h vs. 72 (51-170) h. The difference was 23 (CI 95 % 18-42) h (P = 0.001). Length of hospital stay also shorter in group L compared to group M: median (range) 3 (2-17) vs. 4 (2-14) days (P = 0.029). Patient satisfaction was greater in group L compared to group M (P = 0.001), but no differences were found in knee function, side effects or in patient-related outcomes, Oxford Knee score or EQ-5D.

    CONCLUSIONS: LIA technique provided better postoperative analgesia and earlier mobilization, resulting in shorter hospital stay, compared to intrathecal morphine following TKA.

  • 11.
    Fant, Federica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sandblom, Dag
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Andersson, Swen-Olof
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study2011In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, no 5, p. 782-789Article in journal (Refereed)
    Abstract [en]

    Background.Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA).

    Methods.Fifty patients, ASA I–II, participated in this prospective, doubleblinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient- ontrolled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml21 via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h–1 of ropivacaine 1 mg ml–1, fentanyl 2mg ml21, and epinephrine 2mg ml21 epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required.

    Results.Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0–10)] compared with Group PCLA [4 (0–10)] (P,0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (P,0.05). Morphine consumption was significantly greater in Group PCLA [12 (0–46)] compared with Group TEA [0 (0–20)] at 0–48 h after operation [median (range)] (P¼0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (P,0.01).Conclusions.TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.

  • 12.
    Fant, Federica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tina, E.
    Clinical Reaserch Centre, Örebro University, Sweden.
    Hultgren-Hörnquist, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospita.
    Sandblom, Dag
    Örebro University, School of Health and Medical Sciences.
    Andersson, Swen-Olof
    Örebro University, School of Health and Medical Sciences.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response following radical retropubic prostatectomyManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Epidural anesthesia and analgesia has been shown to suppress the neurohormonalstress response in certain types of surgery, but its role in the inflammatory responseto surgery is unclear. The primary aim of this study was to assess whether the choice ofanalgesic technique influences these processes in patients undergoing radical retropubicprostatectomy (RRP).

    Method: 26 patients undergoing RRP were randomized to Group P (systemic opioid-basedanalgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction andmaintenance of anesthesia in both groups followed a standardized protocol. The followingmeasurements were made perioperatively : plasma cortisol, glucose, insulin, plasma cytokines(IL-6, TNF-a) and pokeweed mitogen-stimulated cytokines (IFN-g, IL-2, IL-12p70, IL-10,IL-4, and IL-17), C-reactive proteins and leucocyte count. Other parameters recordedincluded pain, morphine consumption and perioperative complications during 72 hours.

    Results: Plasma concentration of cortisol and glucose were significantly higher in Group Pcompared to Group E at the end of surgery with a mean difference between groups of 232nmol/L (95% CI 84-381) (P=0.004) and 1.6 mmol/L (95% CI 0.6-2.5) (P=0.003) respectively.No significant differences were seen in any plasma cytokine except IL-17, which was higherin Group P compared with Group E, both at 24 h (P< 0.001) and 72 h (P=0.018)postoperatively. Significantly higher pain intensity was seen up to 24 hours postoperatively inGroup P compared to Group E (p < 0.05).

    Conclusion: Thoracic epidural analgesia reduces the early postoperative stress response butnot the acute inflammatory response to radical retrobupic prostatectomy suggesting that otherpathways are involved during the acute phase reaction.

  • 13.
    Fant, Federica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tina, E.
    Sandblom, Dag
    Örebro University, School of Health and Medical Sciences.
    Andersson, Swen-Olof
    Örebro University, School of Health and Medical Sciences.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital.
    Hultgren-Hörnquist, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Early perioperative immunological effects of anesthesia and analgesia in patients undergoing prostate cancer surgeryManuscript (preprint) (Other academic)
    Abstract [en]

    Background:Clinical studies in humans as well as experimental evidence from animal studiessuggests that the immune system plays an important role in perioperative metastases following cancer surgery. However, the precise role of the different components of the immune system in this process appears conflicting. Our primary aim was to assess T cell activity and natural killer (NK) cell toxicity in patients undergoing prostate cancer surgery and randomized to epidural or intravenous analgesia.

    Methods:26 patients were randomized to receive general anaesthesia and patient controlled analgesia (PCA) with morphine postoperatively (Group P) or combined, general and epidural anaestesia with patient-controlled thoracic epidural analgesia postoperatively (Group E). Blood sample were obtained perioperatively at different time points for analyses of: subpopulations of leukocytes, cell- ediated immune response after mitogen stimulation, NK cell cytotoxicity, vascular endothelial growth factor (VEGF), IFN-g/IL-10 ratio, C-reactive protein (CRP) and white blood cell (WBC) count. In addition, pain and morphine consumtion were also determined.

    Results: T lymphocytes decreased more in Group P compared to Group E at 24 hours postoperatively while T-helper lymphocytes decreased more in Group E compared to Group P at the same time point without reaching statistically significant difference.No differences were seen in NK cells or cytotoxic T lymphocytes between the groups. The CD4+/CD8+ ratio remained constant between the groups over time. Natural Killer Cell cytotoxicity did not show statistically significant differences between the groups at the different postoperative time points. No other differences ere found between the groups except in pain intensity which was lower in Group E, and morphine consumption which was greater in Group P. Conclusions:Our findings suggest that regional anaesthesia and analgesia appears to play a minor role in immunomodulation following surgery for prostate cancer. If regional anesthesia does prevent tumour growth or metastases perioperatively, the mechanism for this needs to be further elucidated.

  • 14.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences.
    Evidence-based medicine in day surgery2007In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 20, no 6, p. 520-525Article in journal (Refereed)
    Abstract [en]

    PURPOSE OF REVIEW: To present the evidence available for the management of pain, for the prevention of nausea and vomiting, and for the best anaesthetic technique during ambulatory surgery.

    RECENT FINDINGS: Paracetamol and nonsteroidal anti-inflammatory drugs are effective analgesics with a low number needed to treat, and are recommended when not contraindicated. Droperidol, dexamethasone and ondansetron are equally effective in the prevention of postoperative nausea and vomiting during ambulatory surgery. The choice of the anaesthetic technique appears to play a minor role in recovery from anaesthesia or in the occurrence of minor postoperative complications or home discharge, except for the use of total intravenous anaesthesia for the prevention of postoperative nausea and vomiting.

    SUMMARY: Pain should be prevented adequately and treated vigorously. Postoperative nausea and vomiting is common and should be prevented in the at-risk patient. The choice of inhalation agents during ambulatory surgery is of minor importance in recovery from anaesthesia.

  • 15.
    Gupta, Anil
    et al.
    Örebro University, School of Health and Medical Sciences.
    Fant, Federica
    Örebro University, School of Health and Medical Sciences.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences.
    Sandblom, Dag
    Rykowski, Jan
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences.
    Andersson, Swen-Olof
    Örebro University, School of Health and Medical Sciences.
    Postoperative analgesia after radical retropubic prostatectomy: a double-blind comparison between low thoracic epidural and patient-controlled intravenous analgesia2006In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 105, no 4, p. 784-793Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated. Low thoracic epidural analgesia and patient-controlled intravenous analgesia were compared in this double-blind, randomized study.

    METHODS: Sixty patients were randomly assigned to receive either low thoracic epidural analgesia (group E) or patient-controlled intravenous analgesia (group P) for postoperative pain relief. All patients had general anesthesia combined with thoracic epidural analgesia during the operation. Postoperatively, patients in group E received an infusion of 1 mg/ml ropivacaine, 2 microg/ml fentanyl, and 2 microg/ml adrenaline, 10 ml/h during 48 h epidurally, and a placebo patient-controlled intravenous analgesia pump intravenously. Patients in group P received a patient-controlled intravenous analgesia pump with morphine intravenously and 10 ml/h placebo epidurally. Pain, the primary outcome variable, was measured using the numeric rating scale at rest (incision pain and "deep" visceral pain) and on coughing. Secondary outcome variables included gastrointestinal function, respiratory function, mobilization, and full recovery. Health-related quality of life was measured using the Short Form-36 questionnaire, and plasma concentration of fentanyl was measured in five patients to exclude a systemic effect of fentanyl.

    RESULTS: Incisional pain and pain on coughing were lower in group E compared with group P at 2-24 h, as was deep pain between 3 and 24 h postoperatively (P < 0.05). Maximum expiratory pressure was greater in group E at 4 and 24 h (P < 0.05) compared with group P. No difference in time to home discharge was found between the groups. The mean plasma fentanyl concentration varied from 0.2 to 0.3 ng/ml during 0-48 h postoperatively. At 1 month, the scores on emotional role, physical functioning, and general health of the Short Form-36 were higher in group E compared with group P. However, no group x time interaction was found in the Short Form-36.

    CONCLUSIONS: The authors found evidence for better pain relief and improved expiratory muscle function in patients receiving low thoracic epidural analgesia compared with patient-controlled analgesia for radical retropubic prostatectomy. Low thoracic epidural analgesia can be recommended as a good method for postoperative analgesia after abdominal surgery.

  • 16.
    Gupta, Anil
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anesthesiology, University hospital, Örebro.
    Perniola, Andrea
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anesthesiology, University hospital, Örebro.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anesthesiology, University hospital, Örebro.
    Thörn, Sven E.
    Division of Anesthesiology, University hospital, Örebro.
    Crafoord, Kristina
    Obstetrics and Gynecology, University hospital, Örebro.
    Rawal, Narinder
    University hospital, Örebro.
    Postoperative pain after abdominal hysterectomy: A double-blind comparison between placebo and local anesthetic infused intraperitoneally2004In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 99, no 4, p. 1173-1179Article in journal (Refereed)
    Abstract [en]

    Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I-II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0-72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods. Total ketobemidone consumption during 4-24 h was significantly less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less frequent incidence of postoperative nausea, but not vomiting, was also found during 4-24 h in group L compared with group P (P < 0.025). Total and free plasma concentrations of levobupivacaine were small. We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects.

  • 17. Holmfred, Anette
    et al.
    Vikerfors, Thomas
    Berggren, Lars
    Örebro University, School of Health and Medical Sciences.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences.
    Intrathecal catheters with subcutaneous port systems in patients with severe cancer-related pain managed out of hospital: the risk of infection2006In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 31, no 6, p. 568-572Article in journal (Refereed)
    Abstract [en]

    Intrathecal catheters have been used for many years to treat severe pain resistant to conventional treatment modalities. Previous studies have found a rate of serious infection of 2%-3% using these catheters in home situations. However, many authors used prophylactic antibiotics routinely in this group of patients, which are both costly and associated with a risk of developing antibiotic resistance. We were interested in studying whether improved hygiene during insertion and care of these catheters in the hospice or home environment would reduce the incidence of catheter-related infections. The results show that prophylactic antibiotic is not necessary, but a careful handling of the system with aseptic technique is important. The infections we registered appeared more than 2 weeks after insertion of the catheters. We now use this method routinely when inserting an intrathecal catheter with a subcutaneous port.

  • 18.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gender differences in Risk factors for Airway Symptoms following Tracheal Intubation2013Conference paper (Refereed)
  • 19.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Centre of Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Gender differences in risk factors for airway symptoms following tracheal intubation2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 10, p. 1306-1313Article in journal (Refereed)
    Abstract [en]

    Background: A common complaint after endotracheal intubation is sore throat and hoarseness. The aim of this study was to describe gender differences and independent risk factors in the development of post-operative sore throat and hoarseness after endotracheal intubation in adults.

    Methods: This prospective cross-sectional observational study was conducted at a university hospital in Sweden. A total of 495 patients were included (203 men and 292 women) and enrolled from a total of eight different surgical departments. Outcome variables were post-operative sore throat and hoarseness evaluated post-operatively in the post-anaesthesia care unit. A total of 31 variables were recorded which described the intubation process, intraoperative factors as well as the extubation process. Bivariate and multivariate analyses were performed.

    Results: The overall incidence of post-operative sore throat was 35% and hoarseness 59%. The results show different predictors for men and women in the development of airway symptoms. The main risk factor for developing sore throat in men was intubation by personnel with <?3 months' work experience. In women, it was endotracheal tube size 7.0 and multiple laryngoscopies during intubation. The main risk factors for hoarseness were cuff pressure for both men and women, and oesophageal temperature probe in women.

    Conclusion: Post-operative sore throat and hoarseness result from several factors, and the cause of these symptoms are multifactorial and differs by gender. Identification of these factors pre-operatively may increase awareness among anaesthesia personnel and possibly reduce the incidence of these minor but distressing symptoms.

  • 20.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Division of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, no 56Article in journal (Refereed)
    Abstract [en]

    Background and objective. Postoperative sore throat and hoarseness are common minor complications following airway manipulation. This study was primarily done to determine gender differences in the incidence of these symptoms and the location of POST after laryngeal mask airway (LMA) and endotracheal tube (ETT).

    Methods. A total of 112 men and 185 women were included during a four month period. All patients were evaluated postoperatively and after 24 hours about the occurrence of sore throat, its location and hoarseness. If the patients had any symptom, they were followed-up at 48, 72 and 96 hours until the symptoms resolved.

    Results. There was no significant gender difference in postoperative sore throat (POST) and postoperative hoarseness (PH) when analyzing both airway devices together. The incidence of sore throat and hoarseness were higher postoperatively after an ETT than an LMA (32% vs. 19%, p= 0.012) and 57% vs. 33% (p< 0.001) respectively. Significantly more women than men had POST after an LMA (26% vs. 6%, p=0.004). No significant gender difference was found in either POST or PH after an ETT or in the incidence of PH after an LMA. More patients located their pain below the larynx after an ETT vs. an LMA (24% vs. 4%). Pain above the larynx was more common after an LMA than an ETT (52 % vs. 37 %).

    Conclusions.  In a clinical setting where women are intubated with a smaller size ETT than men, there were no significant differences in POST or PH between genders. Additionally, more women than men have POST when an LMA is used. Awareness of POST and PH may help streamline patients in whom the best airway device could be used during anesthesia and surgery.

  • 21.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälsa för halsen: Forskning om ont i halsen och heshet efter generell anestesi2014Conference paper (Other academic)
  • 22.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Secondary analysis of risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women2012Conference paper (Refereed)
    Abstract [en]

    Introduction with Hypothesis: Postoperative sore throat (POST) and postoperative hoarseness (PH) are common but disturbing complications following endotracheal intubation. Previously recognized risk factors for POST are: female gender, the size of endotracheal tube, grade of difficulty in intubation, duration of surgery (1, 2) and increased cuff pressure. There is inconsistency in the literature as to the age group that is at greatest risk for developing POST (1). Risk factors associated with PH are endotracheal tube size (3) and non-optimal intubation conditions . Therefore, identification of risk factors associated with POST and PH would add to our knowledge of predictors of poor outcome in our patients.

    Methods: This was a secondary analysis of prospective, cross-sectional data collected from patients previously enrolled in a randomized controlled trial (n=100 women). Eight different variables were analyzed in order to detect possible association between endotracheal intubation and the development of POST or PH. At the Post-Anaesthesia Care Unit, the patients rated their POST on a four-point scale (0=none, 1= mild, 2=moderate, 3=severe). The data was dichotomized, to sore throat (grade 1-3 on the four-grade scale) and no sore throat (grade 0 on the same scale). PH was assessed on a binary scale. The independent variables were analyzed against the dependent variables  using the Chi-Square test, and the odds ratio (OR) and confidence interval (CI) were calculated for each significant variable.  

    Results: Three patients were excluded. Thus, a total of 97 women completed the study.Three variables were found to be significant risk factors for the development of POST: age >60 yrs n=14/22 (63%) vs. 18-60: n=24/75 (32%) (P  = 0.008), endotracheal tube size 7.0 i.e n=25/49 (51 %) vs. ETT 6.0: n= 13/48 (27 %) (P = 0.016) and the use of throat pack i.e n= 9/14 (64 %) vs. no throat pack: n=29/ 83 (35%) (P  = 0.037). The corresponding odds ratio (OR) for these three risk factors were: age 3.71 (95% CI 1.4-10.1), ETT 2.80 (95% CI 1.2-6.6) and throat pack  3.35 (95% CI 1.0-10.9) respectively. 20 cm i.e n= 17/29 (59 %) vs. > 20 cmH2O: 24/67 (36%) (P= 0.038). The OR was 2.5 (95 % CI 1.0-6.1) if the cuff pressure was < 20 cm H2O compared to if the cuff pressure was > 20 cm H2O. 

    Discussion and Conclusion: Patient-reported outcome measures research is based on the knowledge that we, as nurse anesthetists, get some insight into how the patient perceives different situations. Therefore, it is important to increase our knowledge of the patients at risk and the conditions under which this risk increases. In conclusion, we found that women over 60 years, a larger size on the endotracheal tube or the use of a throat pack are at an increased risk for developing postoperative sore throat. A lower cuff pressure was the only factor that contributed towards postoperative hoarseness. 

  • 23.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anestesiology and Intensive Care, Örebro University Hospital, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anestesiology and Intensive Care, Örebro University Hospital, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective studyManuscript (preprint) (Other academic)
  • 24.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Department of Nursing, Umeå University, Umeå, Sweden; Center of Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis2012In: AANA Journal, ISSN 2162-5239, Vol. 80, no 4 (Suppl), p. 67-73Article in journal (Refereed)
    Abstract [en]

    Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness. For data analysis, the χ2 test and the odds ratio were used. Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04),and endotracheal tube No. 7.0 (size 7 mm; P = .02).The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors.

  • 25.
    Jildenstål,, Pether K.
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Hallén, Jan L.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Rawal, Narinder
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology, Linköping University, Linköping, Sweden.
    Berggren, Lars
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden: Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 3, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Background: Post-operative cognitive dysfunction (POCD) after non-cardiac surgery is a well known problem in some categories of patients. This study aims to evaluate the influence of auditory evoked potential (AEP)-guided anaesthesia on the requirement for anaesthetic drugs and their influence on POCD.

    Methods: Four hundred and fifty patients aged between 18 and 92 years scheduled for ophthalmic surgery under general anaesthesia were assigned randomly to one of two groups. In group A (AEP group), the depth of anaesthesia (DoA) was aimed at an AEP index (AAI) between 15 and 25. In group C (control group), DoA was guided by clinical signs. Hypotension was treated with fluids and vasopressors using a standardised algorithm. A mini-mental test and the Cognitive Failure Questionnaire were used to evaluate cognitive function.

    Results: Anaesthetic drug requirements were significantly lower in group A than in group C: propofol 92.526.5 vs. 103.839.5mg (P¼<0.001) and desflurane end-tidal concentration 2.50.58 vs. 3.30.79% (P<0.001). In group A, 36 patients (16%) received additional fluids and vasopressors compared to 65 patients (29%) in group C (P<0.01). AAI values differed significantly between the groups: 18 (11–21) in group A vs. 12 (10–19) in group C (P<0.001). The number of patients with POCD was 16 in group C compared to two in group A (P<0.001) at day 1 post-operation.

    Conclusion: AEP monitoring allows dose reduction of anaesthetic agents, leading to better cardiovascular stability and decreased requirements for intra-operative fluids and vasopressors. Cognitive decline seen following minor ophthalmic surgery, even when anaesthesia is assessed clinically, is short-lived with no long-term sequelae.

  • 26.
    Kuchalik, Jan
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders F.K.
    Tina, Elisabet
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Research Laboratory, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University Hospital. Perioperative Medicine and Intensive Care, Institution for Physiology and Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Anesthesiology and Intensive Care Solna, Karolinska University Hospital, Stockholm, Sweden.
    Does local infiltration analgesia reduce peri-operative inflammation following total hip arthroplasty?: A randomized, double-blind study2017In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, article id 63Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation.

    Methods: This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro-and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively.

    Results: There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups.

    Conclusion: Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes.

  • 27.
    Kuchalik, Jan
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Lundin, Anders
    Department of Orthopaedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology and Intensive Care, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden.
    Local infiltration analgesia: a 2-year follow-up of patients undergoing total hip arthroplasty2017In: Journal of Anesthesia, ISSN 0913-8668, E-ISSN 1438-8359, Vol. 31, no 6, p. 837-845Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Local infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA.

    METHODS: The study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study. The parameters measured were patient-assessed functional outcome [using the Hip dysfunction and Osteo-arthritis Outcome Score (HOOS) questionnaire], health-related quality of life [using the European Quality of Life-5 dimensions (EQ-5D) questionnaire and the 36-Item Short Form Health Survey (SF-36) score], and pain using the numeric rating score (NRS), with persistent post-surgical pain having a NRS of > 3 or a HOOS pain sub-score of > 30. All complications and adverse events were investigated during the first 2 years after primary surgery.

    RESULTS: Pain intensity and rescue analgesic consumption were similar between the groups after hospital discharge. No differences were found in HOOS or SF-36 score between the groups up to 6 months after surgery. A significant group × time interaction was seen in the EQ 5D form in favor of the LIA group. No between-group difference in persistent post-surgical pain was found at 3 or 6 months, or in adverse events up to 2 years after surgery.

    CONCLUSION: Analysis of functional outcome, quality of life, and post-discharge surgical pain did not reveal significant differences between patients receiving LIA and those receiving ITM. LIA was found to be a safe technique for THA during the long-term follow-up. However, it should be noted that these conclusions are based on a limited number of patients.

  • 28. Ng, Huey-Ping
    et al.
    Nordström, Ulf
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences.
    Perniola, Andrea Davide
    Örebro University, School of Health and Medical Sciences.
    Ekbäck, Gustav
    Ryttberg, Lars
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences.
    Efficacy of intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: a randomized double-blind study2006In: Regional anesthesia and pain medicine, ISSN 1098-7339, E-ISSN 1532-8651, Vol. 31, no 1, p. 26-33Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Effective pain relief is important after diagnostic and therapeutic arthroscopic knee surgery to permit early discharge and improve comfort and mobility at home. The aim of this study was to assess the efficacy of bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac injected intra-articularly for postoperative pain relief after arthroscopic knee surgery. METHODS: Sixty-three healthy patients undergoing knee arthroscopy under local anesthesia (LA) were randomized to receive 1 of the following substances intra-articularly postoperatively: group B: 30 mL of bupivacaine (150 mg); group R: 30 mL of ropivacaine (150 mg); and group RMK: ropivacaine 150 mg, morphine 4 mg, and ketorolac 30 mg in normal saline (total volume 30 mL). Oral paracetamol 1g and tramadol 50 mg were used as rescue drugs. Postoperatively, pain was assessed at rest and movement, and side effects were recorded. The patients were asked to self-assess pain for 7 days and record analgesic consumption as well as activities of daily living (ADLs). Plasma concentration of LA was measured in another 8 patients. RESULTS: All groups had excellent analgesia at 0 and 4 hours postoperatively. Group RMK had significantly lower visual analog pain score at rest at 8 hours and during movement at 8 and 24 hours compared with the other groups (P<.05). Group RMK required less paracetamol and tramadol on day 1 (P<.05), had less sleep disturbances because of pain, more patients were ready to work on days 1 and 2 (P<.05), and were more satisfied on days 1 and 4 to 7. Postoperatively, plasma concentrations of ropivacaine and lidocaine were far below known systemic toxic concentrations in all patients. CONCLUSION: Addition of morphine and ketolorac to ropivacaine intra-articularly enhances analgesic efficacy of LA, reduces postdischarge analgesic consumption, and improves ADLs without increasing side effects after ambulatory arthroscopic knee surgery.

  • 29.
    Perniola, Andrea
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Fant, F.
    Department of Anesthesiology and Intensive Care, Örebro University Hospital.
    Magnuson, Anders
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Postoperative pain after abdominal hysterectomy: a randomized, doubleblind,controlled trial comparing continuous infusion vs. patient-controlled intraperitoneal injection of local anesthetic2014In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 112, no 2, p. 328-336Article in journal (Refereed)
    Abstract [en]

    Background. Local anaesthetics (LA) injected intraperitoneally (i.p.) have been found to decrease postoperative pain. This double-blind randomized study was performed comparing continuous infusion or patient-controlled bolus injection of LA i.p. The primary endpoint was supplemental opioid consumption during the first 24 postoperative hours.

    Methods. Two multi-hole catheters were placed i.p. at the end of the surgery in 40 patients undergoing elective abdominal hysterectomy. The patients were randomized into two groups: Group P: patients self-injected 10 ml of levobupivacaine 1.25 mg ml21 via the i.p. catheter as needed, maximum once/hour, and had continuous saline infusion 10 ml h21 into the second catheter. Group C: Patients received a continuous infusion of 10 ml h21 of levobupivacaine 1.25 mg ml21 i.p. through one catheter and 10 ml saline as bolus as needed via the other. Ketobemidone i.v. was administered as rescue medication.

    Results. Total ketobemidone consumption during 0–24 hwas lower in Group P compared with Group C, (mean 23.1 vs 35.7 mg, P¼0.04). No differences in the median pain scores were found between the groups. Earlier return of gastrointestinal (GI) function was found in Group P vs Group C (mean 1.5 vs 2.2 days, P,0.01), which also resulted in earlier home-readiness (mean 1.9 vs 2.7 days, P¼0.04).

    Conclusions. A statistically significant opioid-sparing effect was found when patientcontrolled levobupivacaine was administered i.p. as needed compared with continuous infusion. This was associated with a faster return of GI function and home-readiness. There was, however, a wide confidence interval in the primary endpoint, opioid consumption.

  • 30.
    Perniola, Andrea
    et al.
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro; Linköping University, Linköping, Sweden.
    Crafoord, Kristina
    Department of Obstetrics and Gynecology, University Hospital, Örebro.
    Darvish, Bijan
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    Magnuson, Anders
    Statistical and Epidemiology Unit, University Hospital, Örebro and.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    A double-blind dose-finding study of local anesthetics infused intraperitoneally for postoperative pain relief following abdominal hysterectomy.2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Background and objective Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

    Methods Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml hS1 infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5mghS1; group M, 12.5mghS1 and group H, 17.5mghS1. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

    Results No differences were found between the active groups in pain intensity, recovery parameters or healthrelated quality of life. Pain intensity was maximal during 0– 4 h and during coughing. Expiratory muscle strength decreased significantly during 0–4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters. Conclusion Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief. Eur J Anaesthesiol 26:421–429 Q 2009 European Society of Anaesthesiology

  • 31.
    Perniola, Andrea
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gupta, Anil
    Crafoord, Kristina
    Darvish, Bijan
    Magnuson, Anders
    Axelsson, Kjell
    Intraabdominal local anaesthetics for postoperative pain relief following abdominal hysterectomy: a randomized, double-blind, dose-finding study2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 5, p. 421-429Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

    METHODS: Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml h infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5 mg h; group M, 12.5 mg h and group H, 17.5 mg h. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient-controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

    RESULTS: No differences were found between the active groups in pain intensity, recovery parameters or health-related quality of life. Pain intensity was maximal during 0-4 h and during coughing. Expiratory muscle strength decreased significantly during 0-4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters.

    CONCLUSION: Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief.

  • 32.
    Perniola, Andrea
    et al.
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro, Sweden.
    Intraperitoneal local anesthetics have predominant local analgesic effect: a randomized, double-blind study2014In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 121, no 2, p. 352-361Article in journal (Refereed)
    Abstract [en]

    Background: It remains unclear whether analgesia from intraperitoneal local anesthetics is via local or central mechanisms. This double-blind clinical trial tests the hypothesis that intraperitoneal local anesthetic is superior to continuous IV infusion for pain management. Primary outcome was morphine consumption during 0 to 24 h.

    Methods: Informed consent was obtained from 60 patients, age 30 to 75 yr, American Society of Anesthesiologists physical status I to II, undergoing abdominal hysterectomy. A computer-generated program randomized patients in parallel arms to group IV: continuous infusion of lidocaine 50 mg/h (10 ml) IV and saline 10 ml/h intermittently intraperitoneal; group IP: injection of lidocaine 50 mg/h (10 ml) once every hour intraperitoneally and continuous infusion of saline 10 ml/h intravenously; and group P (placebo): saline 10 ml/h both intravenously and intermittent intraperitoneal injection. Postoperative morphine consumption, pain intensity, recovery, home discharge, and lidocaine concentrations were measured.

    Results: Morphine consumption during 0 to 24 h was lower in group IP versus group IV, mean difference -22.6 mg (95% CI, 11.4 to 33.8; P < 0.01). No difference was seen between group IV and group P. The total mean plasma concentration of lidocaine in group IP was significantly lower than group IV, 0 to 4.5 h postoperatively (P = 0.03) with no evidence of systemic toxicity. Pain intensity and other recovery parameters were similar between the groups.

    Conclusion: The lower supplemental morphine consumption and plasma lidocaine concentration in group IP would confirm that the effects of local anesthetics are likely to be predominant via local intraperitoneal receptors or anti-inflammatory effects and not via central mechanisms alone.

  • 33.
    Perniola, Andrea
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistical Unit, Clinical Research Center.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Local anesthetics administered intra-peritoneally have predominant localand not central analgesic effect: a randomized, double blind studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background It remains unclear whether the analgesic effect of intraperitoneal local anesthetics (LA) is via local intraperitoneal or central mechanisms. This double blind, randomized study was performed to test the hypothesis that LA given intraperitoneally (IP) are superior to the same dose administered by continuous IV infusion (IV) for treating postoperative pain.

    Methods A multi-hole catheter was placed intraperitoneally at the end of the surgery in 60 patients undergoing elective abdominal hysterectomy. The patients were randomized to: Group IV: a continuous infusion of lidocaine 50 mg/h (10 ml) IV and saline 10 ml/h intermittently IP

    Group IP: an injection of lidocaine 50 mg/h (10ml) once every hour IP and a continuous infusion of saline 10 ml/h IV. Group P: saline 10 ml/h both as continuous IV infusion and intermittent IP injection. Postoperative morphine consumption, pain intensity, recovery parameters, home discharge and lidocaine concentrations were measured.

    Results

    Morphine consumption during 0-24h was lower in Group IP vs. Group IV, mean difference - 22.6 mg (95% CI, 11.4 to 33.8, p < 0.01). No difference was seen between Group IV and Group P in analgesic consumption. The total mean plasma concentration of lidocaine in Group IP was significantly lower than in Group IV, 0 - 4.5h postoperatively (p = 0.03). Pain intensity, recovery parameters and time to home discharge were similar between the groups.

    Conclusion The lower supplemental morphine consumption coupled with a lower plasma lidocaine concentration following intraperitoneal administration would confirm a predominant local rather than central effect of local anesthetics.

  • 34.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Brus, Ole
    Örebro University, Örebro, Sweden.
    Rizzo, Marco
    Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA.
    Pettersson, Kurt
    Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases2015In: Hand Surgery, ISSN 0218-8104, Vol. 20, no 1, article id 81Article in journal (Refereed)
    Abstract [en]

    Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.

    Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.

    Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.

    Conclusions All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.

  • 35.
    Siekmann, Wiebke
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Eintrei, Christina
    Department of Anesthesiology and Intensive care, County Council of Östergötland, Linköping, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sjölander, Anita
    Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Malmö, Sweden.
    Matthiessen, Peter
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Council of Östergötland, Linköping, Sweden.
    Gupta, Anil
    Örebro University, School of Medical Sciences. Karolinska University Hospital, Stockholm, Sweden.
    Surgical and not analgesic technique affects postoperative inflammation following colorectal cancer surgery: a prospective, randomized study2017In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 6, p. O186-O195Article in journal (Refereed)
    Abstract [en]

    AIM: Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery.

    METHODS: 96 patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient controlled intravenous analgesia (group P). Surgery and anaesthesia were standardized in both groups. Plasma cortisol, insulin and serum cytokines (IL-1β,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-13,TNFα,IFNγ,GM-CSF,PGE2 and VEGF) were measured preoperatively (T0), 1-6 hours postoperatively (T1) and 3-5 days postoperatively (T2). Mixed model analysis was used, after logarithmic transformation when appropriate, for analyses of cytokines and stress markers.

    RESULTS: There were no significant differences in any serum cytokine concentration between groups P and E at any time point except in IL-10 which was 87% higher in group P (median and range 4.1 (2.3-9.2) pg/ml,) compared to group E (2.6 (1.3-4.7) pg/ml) (p=0.002) at T1. There was no difference in plasma cortisol and insulin between the groups at any time point after surgery. Significant difference in median serum cytokine concentration was found between open and laparoscopic surgery with higher levels of IL-6,IL-8 and IL-10 at T1 in patients undergoing open surgery compared to laparoscopic surgery. No difference in serum cytokine concentration was detected between the groups or between the surgical technique at T2.

    CONCLUSIONS: Open surgery, compared to laparoscopic surgery, has greater impact on these inflammatory mediators than epidural analgesia vs. intravenous analgesia. This article is protected by copyright. All rights reserved.

  • 36.
    Siekmann, Wiebke
    et al.
    Örebro University, School of Medical Sciences. Anaesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Tina, Elisabet
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Research Laboratory, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Clinical Research Laboratory, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Physiology and Pharma cology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Concentration-dependent cell viability and proliferation in vitro of colon cancer cell lines SW480 and SW620 on exposure to lidocaine or ropivacaine2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1017-1018Article in journal (Other academic)
    Abstract [en]

    Background: Cancer cells change phenotypes and properties when evolving from primary tumor cells to metastatic cells. These changes might affect the response to local anesthetics (LA). The aim of this study was to investigate if lidocaine or ropivacaine have a dose- dependent effect on cell viability and proliferation of a primary and a secondary colon carcinoma cell line in vitro.

    Methods: The colon cancer cell lines SW 480, derived from primary tumor and SW620 from metastatic tumor in the same patient, were exposed to increasing log-concentrations of lidocaine and ropivacaine. Cell viability was measured using CellTiter Blue, and cell proliferation by PKH67, after exposure for up to 72 h.

    Results: Cell viability was not affected after 24 h of exposure. However, the metastatic cell line SW620 showed a significant increase in cell viability at low concentrati ons after 48 and 72 h. Exposure to the higher, but clinically relevant, concentrations of both LA resulted in decreased cell viability in both cell lines. These higher concentrations also showed an inhibitory effect on cell proliferation after 72 h, which was more pronounced for ropivacaine.

    Conclusions: Low concentrations of lidocaine and ropivacaine, as achieved in plasma by epidural infusion of LA, do not have direct antiproliferative effects on these colon cancer cell lines in vitro. Higher concentrations of LA, as during continuous local infiltration into tissues over 72 h, inhibit proliferation of both cancer cell lines. The increase in cell viability seen in SW620 should be investigated and underlying mechanisms further elucidated in future studies.

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