Pain. Give me Bupivacaine.
Skeptik Reviewer: Dr. Ali Albargawi
Clinical Fellow, Senior Resident, Working Bee, New Dad, Jimmy the Bupivacaine Giver
Case: Your 65 year old female patient is requesting something for pain before her thoracotomy for lung cancer resection. She saw a movie on Netflix about Bupivacaine and wondered if that’s something she could have.
Reference:Nosotti M, Rosso L, Tosi D, Palleschi A, Mendogni P, Righi I, Marenghi C, Santambrogio L. Preventive analgesia in thoracic surgery: controlled, randomized, double-blinded study. Eur J Cardiothorac Surg. 2014 Dec 18. pii: ezu467. PMID: 25527168
Clinical Question: what is the efficacy of preoparative Dextromethorphan associated with Intercostal nerve Block (IB) using Levobupivacaine
- Population: Thoracotomy patients who refuse or had contraindication to epidural anesthesia.
- Intervention: PreOp Dextromethorphan with IB (PreOp or PostOp)
- Comparison: Placebo
- Outcome: cumulative morphine consumption within 1st two weeks PostPp
Author’s Conclusions: PreOp administration of Dextromethorphan with PreOp IB using Levobupivacaine can provide preventive analgesia decreasing analgesic administration during the early PostOp period.
A. Are the results valid?
- Did the trial ask a clearly focused question? YES
- Was the assignment of patients randomized? UNSURE
- Was randomization process was concealed? YES
- Were all patients who entered the trial accounted for at the end? YES
- Were all of the patients analyzed in the groups to which they were randomized? YES
- Was the follow up of subjects complete and long enough? YES
- Were patients, health workers, assessors “blind” to treatment? YES
- Were the groups similar at the start of the trial? YES
- Apart from the intervention, were the groups treated equally? YES
B. What are the results?
- How large was the treatment effect?
- How precise are the results?
- Do you believe the results? YES
C. Do the results apply to my patients?
- Were the study patients similar to my patients? YES
- Were all clinically important outcomes considered? YES
- Are the benefits worth the harms and costs? UNSURE
Key Results: early postop period vs post thoracotomy syndrome.
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