Anesthesiology
-
Randomized Controlled Trial Clinical Trial
Intravenous diclofenac coupled with PCA fentanyl for pain relief after total hip replacement.
Postoperative pain relief immediately after major surgery cannot be achieved with opioids alone in all patients without respiratory depression or other significant side effects. This investigation was conducted to determine whether the need for opioids and the incidence of side effects can be reduced while maintaining the quality of pain relief using a nonsteroidal antiinflammatory drug as an adjuvant to an opioid. The analgesic efficacy and safety of patient-controlled analgesia using fentanyl with and without intravenous diclofenac were compared after total hip replacement. ⋯ The diclofenac group showed a significant reduction in the amount of fentanyl administered during the first 16 h postoperatively as compared to the placebo group (0.65 mg +/- 0.2 vs. 1.08 mg +/- 0.4 respectively, P less than 0.01), and also reported less pain at 16 h (median score on visual analogue scale 0.75 vs. 2.4 respectively, P less than 0.05)). There were no differences in side effects, postoperative blood loss, plasma activated partial thromboplastin time, or Ivy bleeding time between the groups. In conclusion, the addition of diclofenac led to a reduction in fentanyl requirement but did not have any other significant advantages in the treatment of pain following major orthopedic surgery.
-
Randomized Controlled Trial Clinical Trial
Epidural clonidine after cesarean section. Appropriate dose and effect of prior local anesthetic.
Epidurally administered clonidine represents a new approach to postcesarean section pain therapy, yet the appropriate bolus dose and infusion to provide effective pain relief have not been defined. In addition, whether 2-chloroprocaine, a commonly used local anesthetic for intraoperative anesthesia, interferes with clonidine's analgesia, as it does with that of opioids, has not been examined. In this study, using a randomized, blinded design, 63 women received either bupivacaine or 2-chloroprocaine for epidural anesthesia for cesarean section and then received, upon request for analgesia in the recovery room, epidural clonidine 400 micrograms or 800 micrograms bolus, each followed by a 24-h infusion of 40 micrograms/h, or an equivalent volume bolus and infusion of saline. ⋯ Clonidine did not alter resolution of residual local anesthetic sensory blockade, as measured by 2- or 4-segment regression following either local anesthetic, but did prolong duration of motor blockade in women receiving bupivacaine. Clonidine produced small decreases in heart rate and blood pressure. One patient received iv fluids for hypotension; one had asymptomatic bradycardia resolving without therapy; and one had mild hypoxemia with snoring during clonidine-induced sedation, responding to supplemental oxygen.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Randomized Controlled Trial Comparative Study Clinical Trial
Does epidural administration of butorphanol offer any clinical advantage over the intravenous route? A double-blind, placebo-controlled trial.
The differential effects of intravenous versus epidural administration of short-acting, lipid-soluble opioids is controversial. This study was undertaken to compare these two routes of administration using the mixed agonist-antagonist opioid, butorphanol. Forty-five women undergoing elective cesarean delivery at term under epidural lidocaine anesthesia were randomized to receive a single bolus of either epidural or intravenous butorphanol 2 mg or saline control for postoperative analgesia. ⋯ Analgesia was quantitated using a visual analogue scale and subsequent PCA morphine requirements. The interval from study drug injection until first request for PCA use was equivalent for the intravenous and epidural groups (89 +/- 9 and 83 +/- 8 min, respectively) and significantly longer than in control group (39 +/- 4 min, P less than 0.001, intravenous and epidural vs. control). Analgesia was equivalent in the intravenous and epidural groups at all observation points, and pain scores were significantly lower than control for the first 120 min after study drug injection.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Epidural or intrathecal infusions of morphine and bupivacaine mixtures are presently used for the treatment of "refractory" cancer pain even though the neurotoxic potential of such mixtures is unknown. The pathologic findings of the spinal column, the meninges, the nerve roots, and the spinal cord, and the clinical neurologic deficits were recorded in 15 patients (5 men and 10 women), aged 26-83 (median 68) yr, treated for 4-274 (median 81) days with intrathecal infusions of morphine (with preservatives [sodium metabisulfite and sodium edetate]) and bupivacaine mixtures, given through open, subcutaneously tunneled nylon catheters. Six patients had been subjected to radiation therapy (20-96 Gy), applied over the spinal column, and four had been treated with antineoplastics believed to be neurotoxic. ⋯ The neuropathologic findings were not related to the duration or cumulative doses of the intrathecal treatment. No new neurologic deficits that could be attributed to the intrathecal administration of the opiate-bupivacaine mixtures were recorded. The neuropathologic and clinical neurologic findings in cancer patients treated with intrathecal morphine-bupivacaine mixtures appeared similar to those in animals and humans reported with either intrathecal morphine or bupivacaine alone.