Vascular
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Randomized Controlled Trial
Pain associated with carotid artery surgery performed under carotid plexus block: preemptive analgesic effect of ketorolac.
Carotid artery surgery (CAS) performed under cervical plexus block is frequently associated with significant intra- and postoperative pain. To evaluate whether preoperative administration of ketorolac may improve analgesia in this type of surgery, 80 patients scheduled for CAS under cervical plexus block were randomly allocated to receive intravenously either 30 mg of ketorolac or placebo 30 minutes before surgery. Verbal rating scale pain scores during surgery and 3 and 6 hours after surgery, the number of patients requiring additional analgesia, and the total analgesic consumption both during and within 6 hours after surgery were significantly lower, whereas the time to first postoperative analgesia was significantly shorter in the ketorolac group than in the control group. The results of this prospective, randomized, double-blind study show that a single 30 mg dose of ketorolac administered intravenously 30 minutes before surgery reduces intraoperative pain and preempts postoperative pain in patients undergoing CAS under carotid plexus block.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Hemorrhagic complications during long-term postoperative warfarin administration in patients undergoing lower extremity arterial bypass surgery.
Lower extremity bypass procedures restore function and prevent amputation in many patients with severe peripheral arterial occlusive disease. The regular postoperative use of aspirin offers the dual benefit of extending bypass patency and patient survival. Previous trials of adjunctive oral anticoagulant therapy with warfarin have infrequently combined warfarin with aspirin. ⋯ Compliance with warfarin was maintained in 65% of the patients after the first year of observation. In patients with elective lower extremity bypass procedures, the postoperative adjunctive use of warfarin with aspirin increased the risk of major hemorrhagic events. Most of these events occurred when the INR was in the target range.