2017-18 HSC Section 3 Green Book

E.

Boselli

et

al.

/ Anaesth

Crit

Care

Pain Med

35

(2016)

31–36

relief, defined by

2 mg boluses administered every 5 min until pain

NRS

3

[17] .

Postoperative haematoma

nausea

and

vomiting

(PONV),

a

facial

or

oedema

were

recorded

as

somnolence,

events.

In

case

of

PONV,

4 mg

of

ondansetron

were

adverse

intravenously. When

the Aldrete

recovery

score was

administered

9,

the

patients

were

discharged

to at

the

outpatient

ward using

Postoperative

pain was

evaluated

hours

1,

2

and

4

[18] .

and was

treated with 1 g oral paracetamol in

case of

a

a 0–10 NRS NRS > 3. The

latter was potentially combined with 50 mg

tramadol

the NRS

remained >

3

at

a

second

evaluation.

In

case

of

PONV,

if

the stay

in

the

4 mg of oral ondansetron were administered. During

ward,

the

maximal

NRS

score,

presence/absence recorded. When (PADSS) score was

of

outpatient

facial

haematoma

and

oedema were

the

PONV,

9,

Post-Anaesthesia Discharge Scoring System

[19] . All patients were called on the

patients were discharged home

postoperative

day

to

evaluate

pain

using

a

0–10 NRS,

PONV

first

the quality of analgesia

(poor, average,

and satisfaction concerning

and

excellent).

good

Statistical

analysis

2.3.

primary

endpoint

of

this

study

was

the

total

dose

of

The

morphine

(intraoperative

and

in

the

PACU).

The

perioperative

Fig.

2.

Infratrochlear

nerve

block

landmarks.

endpoints were

the

time

spent

in

the PACU

(time

to

an

secondary

score of

9), outpatient ward

(time

to PADSS of

9), NRS,

Aldrete PONV,

Multimodal analgesia was

administered 30 min before

the end 20 mg

facial

haematoma

or

oedema

in

the

PACU

and

outpatient

surgery

and

consisted

of

1

g

intravenous

paracetamol,

of

and

NRS,

PONV

and

patient

satisfaction

on

the

first

ward

and

0.1 mL/kg

of

the

study

drug

contained

in

syringe

2

nefopam (isotonic

day.

According

to

a

previous

retrospective

study

postoperative

saline

for Group

LB and 1 mg/mL morphine

chlorhydrate

20

patients general

scheduled anaesthesia

for

rhinoseptoplasty

in

our

institution

on

the

control

group).

At

the

end

of

the

procedure,

when

the

for

using

desflurane

and

remifentanil,

the was

under

alert

and

had

a

respiratory

rate >

10

c/min,

tracheal

patient was

mean

SD

total

perioperative

morphine

dose

expected

performed

and

the

patient was

sent

to

the

post- rate,

extubation was

3 mg when

no

facial

block was

performed

and

3

2 mg when

6

care unit

(PACU). pressure,

In

the PACU,

the patient’s heart

anaesthesia non-invasive

a

facial block

(unpublished data). Assuming a

two-sided

type

I

using

blood oxygen saturation were monitored. Postoperative pain was assessed using a numerical rating scale (NRS) varying from 0 (no pain) to 10 (maximum pain imaginable). In case of postoperative pain, defined by a NRS > 3, intravenous morphine titration was performed using respiratory rate and pulse

required

error of 0.05 and a power of 0.90, 16 patients per group were

detect

a

50%

reduction

in

total

morphine

consumption.

This

to

increased

to

20

patients

per

group

to

allow

for

loss

to

number was

are presented as means

SD or medians

[IQR]

for

follow-up. Results

variables

and

numbers

(%)

for

categorical

variables.

continuous

Fig.

3.

The

study

flow

chart.

248