Anesthesiology
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Randomized Controlled Trial Clinical Trial
Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture.
Postdural puncture headache (PDPH) occurs in up to 80% of parturients who experience inadvertent dural puncture during epidural catheter placement. The authors performed a randomized double blind study to assess the effect of prophylactic epidural blood patch on the incidence of PDPH and the need for therapeutic epidural blood patch. ⋯ A decrease in the incidence of PDPH or the need for criteria-directed therapeutic epidural patch was not detected when a prophylactic epidural blood patch was administered to parturients after inadvertent dural puncture. However, prophylactic epidural blood patch did shorten the duration of PDPH symptoms.
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Randomized Controlled Trial Clinical Trial
Intranasal nicotine for postoperative pain treatment.
Despite pharmacological treatment, 70-80% of patients report moderate to severe pain after surgery. Because nicotine has been reported to have analgesic properties in animal and human volunteer studies, the authors assessed the analgesic efficacy of a single 3 mg dose of nicotine nasal spray administered before emergence from general anesthesia. ⋯ Treatment with a single dose of nicotine immediately before emergence from anesthesia was associated with significantly lower reported pain scores during the first day after surgery. The decreased pain was associated with a reduction in morphine utilization and the analgesic effect of nicotine was not associated with hypertension or tachycardia.
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Randomized Controlled Trial Clinical Trial
Chronic oral gabapentin reduces elements of central sensitization in human experimental hyperalgesia.
In chronic pain, increased activity from intact or damaged peripheral nerve endings results in an enhanced response in central pain transmission systems, a mechanism known as central sensitization. Central sensitization can also be invoked in human experimental models. Therefore, these models may be useful to characterize novel analgesics in humans. The anticonvulsant gabapentin has demonstrated efficacy in patients with neuropathic pain, but its mode of action remains unclear. This study examined the effects of gabapentin on signs of central sensitization (brush and pinprick hyperalgesia) in a human model of capsaicin-evoked pain, using a gabapentin dosing regimen similar to that used in the clinic. The aims were to determine whether gabapentin, dosed in a manner similar to that used in the clinic, affected the various components of central sensitization and to assess the utility of this model for characterizing novel analgesics. ⋯ Oral gabapentin, administered to healthy volunteers in a regimen similar to that used in treating chronic neuropathic pain, reduces measures of central sensitization evoked by intradermal capsaicin. This suggests that the pain-relieving effect in chronic neuropathic pain condition is linked to the effect of gabapentin on central sensitization. The ability of the capsaicin model to detect the efficacy of this standard treatment of neuropathic pain suggests that it may have a predictive value for detection of efficacy in human subjects.
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Randomized Controlled Trial Meta Analysis Clinical Trial
Is low-dose haloperidol a useful antiemetic?: A meta-analysis of published and unpublished randomized trials.
The antiemetic efficacy of haloperidol was studied using data from 15 published (1962-1988) and 8 unpublished randomized trials; 1,397 adults received haloperidol, and 1,071 were controls. Settings were postoperative nausea or vomiting (1,994 patients), gastroenterology (261), chemotherapy (189), and radiation therapy (24). The relative benefit to prevent postoperative nausea or vomiting during 24 h with 0.5-4 mg haloperidol compared with placebo was 1.26-1.51 (number needed to treat, 3.2-5.1), without evidence of dose responsiveness; 0.25 mg was not antiemetic. ⋯ There were no reports on cardiac toxicity. Postoperatively and in gastroenterology, haloperidol is antiemetic, with minimal toxicity. For other clinical settings and for children, valid data are unavailable.
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Randomized Controlled Trial Clinical Trial
Proper shoulder position for subclavian venipuncture: a prospective randomized clinical trial and anatomical perspectives using multislice computed tomography.
Although the Trendelenburg position and shoulder bracing are recommended for safe subclavian venipuncture, the optimal shoulder position remains unclear. The current study observed spatial relations between the subclavian vein and surrounding structures using multislice computed tomography to determine optimal shoulder position for safe subclavian venipuncture and then conducted a small follow-up clinical trial to confirm these findings. ⋯ Lowered shoulder position increases both overlap and proximity between the clavicle and the subclavian vein, producing a more constant relation between the clavicle and the subclavian vein, without affecting vein diameter. Proper use of a lowered shoulder position should thus increase the safety and reliability of subclavian venipuncture compared with other shoulder positions.