Is the effect of inguinal field block with 0.5 % bupivacaine on postoperative pain after hernia repair enhanced by addition of ketorolac or S(+) ketamine ?

Résumé Malgré l'apparition de nouvelles techniques chirurgicales dites « sans tension », l'antalgie post-opératoire après cure de hernie inguinale reste un défi pour les anesthésiologistes. Récemment on a suggéré que l'addition de ketamine ou d'un anti-inflammatoire non-stéroïdien (AINS) à un anesthésique local pourrait améliorer et prolonger l'analgésie postopératoire. Le but de cette étude, à laquelle ont participé 36 patients ASA I-II, était d'évaluer si la coadministration de S(+) ketamine ou de ketorolac renforcerait les effets analgésiques de la bupivacaïne après cure ambulatoire de hernie inguinale sous anesthésie générale. L'analgésie a consisté en une infiltration de la plaie associé à un bloc inguinal avec soit 30 ml de bupivacaïne 0,5 % (n=12), soit 27 ml de bupivacaïne 0,5 % + 3 ml de S(+) ketamine (75 mg) (n=12), soit 28 ml de bupivacaïne 0,5 % + 2 ml de ketorolac (60 mg) (n=12). La prise orale d'antalgique en phase postopératoire était standardisée. L'intensité des douleurs a été évaluée au moyen d'une échelle visuelle analogique (EVA), d'un score verbal d'estimation et par algométrie de pression respectivement 2, 4, 6, 24 et 48 heures après l'intervention. Les trois groupes de patients ont présenté le score de douleur évalué par EVA le plus élevé à 24 heures, score significativement différent de ceux mesurés à 6 et 48 heures (P <0.05). A part une sensation de douleurs significativement moindre (score verbal d'estimation) dans le groupe ketorolac à 24 et 48 heures et seulement à 48 heures dans le groupe ketamine, il n'y avait aucune autre différence entre les groupes pour la durée de l'étude (48 heures) en ce qui concerne les scores de douleur, les seuils de douleur à la pression ou la prise postopératoire d'antalgiques « de secours ». En conclusion, l'addition de S(+) ketamine ou de ketorolac, n'améliore que marginalement l'effet analgésique de la bupivacaïne. Ceci peut-être mis en relation avec la technique de cure de hernie « sans tension » induisant un bas niveau de douleur postopératoire. Abstract Objective: The aim of the study was to assess whether coadministration of S(±) ketamine or ketorolac would enhance or prolong local analgesic effect of bupivacaine after inguinal hernia repair. Design: Prospective double-blind randomized study evaluating pain intensity after surgery under general anesthesia. Setting: Outpatient facilities of the University Hospital of Lausanne. Patient: Thirty-six ASA I-II outpatients scheduled for elective day-case inguinal herniorraphy. Intervention: Analgesia strategy consisted of a wound infiltration and an inguinal field block either with 30 mL bupivacairie (0.5%) or with the same volume of a mixture of 27 mL bupivacaine (0.5%) + 3 mL S(+) ketamine (75 mg) or a 28 mL bupivacaine (0.5%) + 2 ML ketorolac (60 mg). Postoperative analgesic regimen was standardized. Outcome Measures: Pain intensity was assessed with a Visual Analog Seale, a verbal rating score, and by pressure algometry 2, 4, 6, 24, and 48 hours after surgery. Results: The 3 groups of patients experienced the highest Visual Analog Scale pain score at 24 hours, which was different from those at 6 and 48 hours (P < 0.05). Apart from a significantly lower pain sensation (verbal rating score) in the ketorolac group at 24 and 48 hours and only at 48 hours with ketamine, there were no other differences in pain scores, pain pressure thresholds, or rescue analgesic consumption between groups throughout the 48-hour study period. Conclusion: The addition of S (+)-ketamine or ketorolac only minimally improves the analgesic effect of bupivacaine. This may be related to the tension-free hernia repair technique associated with low postoperative pain.

A comparative analysis of two methods for the calculation of electric-field-induced perturbations to molecular vibration

Two common methods of accounting for electric-field-induced perturbations to molecular vibration are analyzed and compared. The first method is based on a perturbation-theoretic treatment and the second on a finite-field treatment. The relationship between the two, which is not immediately apparent, is made by developing an algebraic formalism for the latter. Some of the higher-order terms in this development are documented here for the first time. As well as considering vibrational dipole polarizabilities and hyperpolarizabilities, we also make mention of the vibrational Stark effec

Cosmopolitan Capital and the Internationalization of the Field of Business Elites: Evidence from the Swiss Case

The aim of this contribution is to explore how the recent internationalization and the increasing importance of 'cosmopolitan capital' has impacted on the structure and character of the field of the Swiss business elite. For this purpose we will develop the notion of cosmopolitan capital and comparatively investigate the field of the Swiss business elite in 1980, 2000 and 2010 with multiple correspondence analysis. We can show that in this period international managers with transnational careers and networks not only grow in number, but come to conquer the apex of the biggest and highest capitalized Swiss firms. At the same time, national forms of capital decline in importance and Swiss managers themselves are differentiated increasingly into national and international fractions.

Genetic homogeneity of dolphinfish (Coryphaena hippurus) in the western Mediterranean and the eastern Atlantic

Dolphinfish (Coryphaena hippurus) is an epipelagic, highly migratory species distributed worldwide in tropical and temperate waters including the Mediterranean Sea. Protein electrophoresis analyses can provide knowledge of the genetic population structure of the species and therefore be used as a tool for fishery management. Areas sampled include the islands of Majorca and Sicily in the western Mediterranean and the Canary Islands in the eastern Atlantic. The results of the protein electrophoresis reveal a level of genetic variability similar to other highly migratory species. No differences were found among locations, and it was not possible to reject the null hypothesis of one panmictic population in the area studied

Maturity of Concrete: Field Implementation, MLR-96-1, 1996

The result and experience of field implementation of the maturity method on 14 portland cement concrete (PCC) paving and patching projects during 1995 are summarized in this report. The procedure for developing reference PCC maturity-strength curve of concrete is discussed. Temperature measurement as well as effects of datum temperature, entrained air content and type of aggregate on maturity-strength relationship are examined. Some limitations of the maturity method are discussed. The available field experience and results indicate that the maturity method provides a simple approach to determine strength of concrete, and can be easily implemented in field paving and patching projects. The use of the maturity method may result in reduced project construction time.

Influence of magnetic field strength and image registration strategy on voxel-based morphometry in a study of Alzheimer's disease.

Multi-centre data repositories like the Alzheimer's Disease Neuroimaging Initiative (ADNI) offer a unique research platform, but pose questions concerning comparability of results when using a range of imaging protocols and data processing algorithms. The variability is mainly due to the non-quantitative character of the widely used structural T1-weighted magnetic resonance (MR) images. Although the stability of the main effect of Alzheimer's disease (AD) on brain structure across platforms and field strength has been addressed in previous studies using multi-site MR images, there are only sparse empirically-based recommendations for processing and analysis of pooled multi-centre structural MR data acquired at different magnetic field strengths (MFS). Aiming to minimise potential systematic bias when using ADNI data we investigate the specific contributions of spatial registration strategies and the impact of MFS on voxel-based morphometry in AD. We perform a whole-brain analysis within the framework of Statistical Parametric Mapping, testing for main effects of various diffeomorphic spatial registration strategies, of MFS and their interaction with disease status. Beyond the confirmation of medial temporal lobe volume loss in AD, we detect a significant impact of spatial registration strategy on estimation of AD related atrophy. Additionally, we report a significant effect of MFS on the assessment of brain anatomy (i) in the cerebellum, (ii) the precentral gyrus and (iii) the thalamus bilaterally, showing no interaction with the disease status. We provide empirical evidence in support of pooling data in multi-centre VBM studies irrespective of disease status or MFS.

A Continuous Span Aluminum Girder Concrete Deck Bridge - Part 1 of 2: Field Test Performance and Evaluation, 1996

This report addresses the field testing and analysis of those results to establish the behavior of the original Clive Road Bridge that carried highway traffic over Interstate 80 (I-80) in the northwest region of Des Moines, Iowa. The bridge was load tested in 1959, shortly after its construction and in 1993, just prior to its demolition. This report presents some of the results from both field tests, finite element predictions of the behavior of aluminum bridge girders, and load distribution studies.

Computational and Experimental Analysis of Flow Field in the Diffusers of Centrifugal Compressors

Centrifugal compressors are widely used for example in process industry, oil and gas industry, in small gas turbines and turbochargers. In order to achieve lower consumption of energy and operation costs the efficiency of the compressor needs to be improve. In the present work different pinches and low solidity vaned diffusers were utilized in order to improve the efficiency of a medium size centrifugal compressor. In this study, pinch means the decrement of the diffuser flow passage height. First different geometries were analyzed using computational fluid dynamics. The flow solver Finflo was used to solve the flow field. Finflo is a Navier-Stokes solver. The solver is capable to solve compressible, incompressible, steady and unsteady flow fields. Chien's k-e turbulence model was used. One of the numerically investigated pinched diffuser and one low solidity vaned diffuser were studied experimentally. The overall performance of the compressor and the static pressure distribution before and after the diffuser were measured. The flow entering and leaving the diffuser was measured using a three-hole Cobra-probe and Kiel-probes. The pinch and the low solidity vaned diffuser increased the efficiency of the compressor. Highest isentropic efficiency increment obtained was 3\% of the design isentropic efficiency of the original geometry. It was noticed in the numerical results that the pinch made to the hub and the shroud wall was most beneficial to the operation of the compressor. Also the pinch made to the hub was better than the pinchmade to the shroud. The pinch did not affect the operation range of the compressor, but the low solidity vaned diffuser slightly decreased the operation range.The unsteady phenomena in the vaneless diffuser were studied experimentally andnumerically. The unsteady static pressure was measured at the diffuser inlet and outlet, and time-accurate numerical simulation was conducted. The unsteady static pressure showed that most of the pressure variations lay at the passing frequency of every second blade. The pressure variations did not vanish in the diffuser and were visible at the diffuser outlet. However, the amplitude of the pressure variations decreased in the diffuser. The time-accurate calculations showed quite a good agreement with the measured data. Agreement was very good at the design operation point, even though the computational grid was not dense enough inthe volute and in the exit cone. The time-accurate calculation over-predicted the amplitude of the pressure variations at high flow.

Unexplored aspects of bureaucratic autonomy: a state of the field and ways forward

This article first provides a selective overview of the literature on bureaucratic autonomy and identifies different approaches to this topic. The second section discusses three major sets of open questions, which will be tackled in the contributions to this special issue: the subjective, dynamic and relational nature of autonomy; the complex linkages between tasks, organizational forms, and national path dependencies on the one hand and autonomy and performance on the other hand; and the interplay between autonomy, accountability and democratic legitimacy.

Syntheses of niobium oxide in the presence of magnetic field and determination of physical properties

Now when the technology fast developing it is very important to control the formation of materials with better properties. In the scientific literature there is a number of works describing the influence of magnetic field on the properties and process of formation of materials. The goal of this master's thesis is to analyze the process of electrochemical synthesis of niobium oxide in the present of magnetic field, to compare properties of formed oxide films and to estimate the influence of magnetic field on the process and on the result of synthesis.

The Making of Experimental Economics: Witness Seminar on the Emergence of a Field

This book is the transcript of a witness seminar on the history of experimental economics, in which eleven high-profile experimental economists participated, including Nobel Laureates Vernon Smith, Reinhard Selten and Alvin Roth. The witness seminar was constructed along four different topics: skills, community, laboratory, and funding. The transcript is preceded by an introduction explaining the method of the witness seminar and its specific set-up and resuming its results. The participants' contribution and their lively discussion provide a wealth of insights into the emergence of experimental economics as a field of research.

Chaotic dynamics of electric-field domains in periodically driven superlattices

Self-sustained time-dependent current oscillations under dc voltage bias have been observed in recent experiments on n-doped semiconductor superlattices with sequential resonant tunneling. The current oscillations are caused by the motion and recycling of the domain wall separating low- and high-electric-field regions of the superlattice, as the analysis of a discrete drift model shows and experimental evidence supports. Numerical simulation shows that different nonlinear dynamical regimes of the domain wall appear when an external microwave signal is superimposed on the dc bias and its driving frequency and driving amplitude vary. On the frequency-amplitude parameter plane, there are regions of entrainment and quasiperiodicity forming Arnold tongues. Chaos is demonstrated to appear at the boundaries of the tongues and in the regions where they overlap. Coexistence of up to four electric-field domains randomly nucleated in space is detected under ac+dc driving.