Iliac crest bone harvest: should we really use continuous infusion of ropivacaine?
نویسندگان
چکیده
To the Editor:— We read with interest the study by Scavone et al. that demonstrates the absence of efficacy of a prophylactic epidural blood patch after inadvertent dural puncture. We suggest that two factors could have influenced the negative result of this trial. First, inadvertent dural puncture could have been overdiagnosed, namely when loss of resistance to saline was used to locate epidural space. This could explain the lower incidence of post–dural puncture headache and less frequent realization of therapeutic epidural blood patch reported in this study compared with others. Second, 20 ml may not be the adequate blood volume to test a prophylactic epidural blood patch. This volume has tended to increase over time to 20 ml or more, 23 5 ml in a study by Safat-Tisseront et al. The optimal blood volume may be the volume at which pain in the back, buttocks, or legs occurs, which was only achieved for seven patients in the study of Scavone et al. This higher volume may lead to either a larger patch over the dural tear or a significantly higher increase in lumbar and intracranial pressure, leading to reduced cerebral vasodilation. Olivier Pruszkowski, M.D.,* Orlando Goncalves, M.D., Claude Lentschener, M.D., Alexandre Mignon, M.D., Ph.D. *Hôpital Cochin Maternité Port-Royal, Assistance Publique–Hôpitaux de Paris, Paris, France. [email protected]
منابع مشابه
Analysis of Postoperative Pain at the Anterior Iliac Crest Harvest Site: A Prospective Study of the Intraoperative Local Administration of Ropivacaine
STUDY DESIGN This was a prospective randomized comparative study. PURPOSE The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain...
متن کاملAutogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival.
AIM To analyse the morbidity arising from autogenous bone graft harvesting, graft resorption and implant survival in grafted sites. MATERIALS AND METHODS Only comparative clinical trials on the harvest of autogenous bone grafts were selected. Studies were excluded if they compared autogenous bone grafts to bone substitutes or vascularised free bone grafts. RESULTS A total of 24 studies were...
متن کاملUse of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis
BACKGROUND Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications ...
متن کاملAvulsion fracture of the anterior iliac crest after bone graft harvest: case report and review of techniques, risk factors and treatment.
The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. Avulsion fracture of the iliac crest following bone grafting is an extremely rare occurrence. We present a case report of avulsion fracture of the anterior iliac crest following bone graft harvesting for anterior cervical fus...
متن کاملEffect of the harvest procedure and tissue site on the osteogenic function of and gene expression in human mesenchymal stem cells
Evidence has indicated that mesenchymal stem cells (MSCs) harvested with the Reamer/Irrigator/Aspirator (RIA) procedure exhibited an improved osteogenic differentiation capability compared with MSCs obtained by bone marrow aspiration from the iliac crest. In the present study, we hypothesized that the harvest procedure indeed influences the osteogenic activity of human MSCs more than the tissue...
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ورودعنوان ژورنال:
- Anesthesiology
دوره 103 4 شماره
صفحات -
تاریخ انتشار 2005