Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Clinical TrialOptimal regional anesthesia for circumcision.
Dorsal penile nerve block (DPNB) is a useful procedure for analgesia in circumcision. It has minor complications and a reported failure rate of from 4% to 6.7%. To evaluate the intraoperative value of additional anesthesia of the perineal nerves--a branch of the pudendal nerve--during circumcision, we conducted a prospective randomized double-blind study on 250 adults. ⋯ On the other hand, only six patients (4%) in Group II had a mild diffused discomfort with no need for additional local anesthesia (P < 0.01). The average operating time was 12.4 +/- 2.7 min (range 9-22 min) in Group I and 10.7 +/- 1.6 min (range 8-15 min) in Group II (P < 0.001). We think that perineal nerves play an important part in innervation of the penis and must be anesthetized during the penile block.
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Clinical TrialResidual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy.
After laparoscopic cholecystectomy, residual gas is inevitably retained in the peritoneal cavity. An active attempt is not always made to remove it. Using a double-blind prospective protocol in 40 healthy patients, we evaluated the effect of residual pneumoperitoneum on post-laparoscopic cholecystectomy pain intensity. ⋯ During the first postoperative hour, the NAA patients made significantly (P < 0.05) more demands (mean +/- SD) for morphine than those in the AA group (31.3 +/- 26.2 vs 15.3 +/- 15.7) and also received a borderline significantly (P = 0.056) larger dose (mean +/- SD) of PCA morphine (3.9 +/- 1.9 mg vs 2.7 +/- 1.3 mg). The VAS scores (mean +/- SD) over the 4-h study period were similar in both groups, being high during the first postoperative hour (AA = 5.1 +/- 2.1 vs NAA = 6.1 +/- 2.2) and then decreasing. We conclude that residual pneumoperitoneum is a contributing factor in the etiology of postoperative pain after laparoscopic cholecystectomy.
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Anesthesia and analgesia · Jul 1994
Clinical Trial Controlled Clinical TrialIntraoperative combined administration of indomethacin and buprenorphine suppositories as prophylactic therapy for post-open-cholecystectomy pain.
Buprenorphine and indomethacin are quite different pharmacologically. The objective of this study was to determine the analgesic effect from their combined administration in suppository form. Eighty patients undergoing open cholecystectomy under nitrous oxide-oxygen-sevoflurane anesthesia, in addition to epidural anesthesia using lidocaine, were divided into four groups: Group A received buprenorphine 0.4 mg and indomethacin 50 mg; Group B, buprenorphine 0.4 mg; Group C, indomethacin 50 mg; and Group D, no drug. ⋯ Patients in Group A required fewer analgesics, had a longer period of analgesic effect from the end of surgery, and enjoyed a better pain score. This group also included more patients who required no analgesics. We conclude that the combined administration of opioid and nonopioid suppositories may provide far better prophylactic analgesia than a single drug.
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Clinical TrialSystemic opioids enhance the spread of sensory analgesia produced by intrathecal lidocaine.
The effect of different doses of fentanyl and nalbuphine on the spread of spinal analgesia produced by lidocaine was studied in 68 patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia. Patients were randomly assigned to six groups: fentanyl A, B, or C (FA, FB, FC) or nalbuphine A, B, or C (NA, NB, NC), which received intravenous (i.v.) 50, 100, or 150 micrograms of fentanyl or 10, 15, or 20 mg of nalbuphine, respectively, 20 min after spinal anesthesia with lidocaine. We tested the level of spinal analgesia with pinprick sensation 20 min after spinal anesthesia and 10 min after the opioid administration, when 0.4 mg of naloxone was administered i.v. ⋯ Ten minutes after fentanyl or nalbuphine, the level of analgesia increased (1.8 +/- 1.7, 3.1 +/- 1.2, and 4.1 +/- 1.5 cm, in the FA, FB, and FC groups and 1.9 +/- 0.9, 2.6 +/- 1.4, and 3.7 +/- 2.2 cm in the NA, NB, and NC groups, respectively). The increases in the level of analgesia differed significantly between the fentanyl groups (F = 8.0939; df = 2.35; P < 0.001), the increase produced by 150 micrograms being significantly higher than produced by 50 micrograms of fentanyl (limits of confidence -4.236809 and -0.4431909; P < 0.01). Naloxone reversed the effect of fentanyl and 10 min after its administration the fentanyl groups did not differ with regard to the level of spinal analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Jul 1994
Histopathology after repeated intrathecal injections of preservative-free ketamine in the rabbit: a light and electron microscopic examination.
Epidural and spinal administration of ketamine has been used in humans. Single-dose studies have shown that preservative-free ketamine lacks neurotoxic effects, but there are no studies after repeated administrations. The aim of this study was to examine the effects of daily administration of preservative-free ketamine. ⋯ Light microscopic, electron microscopic, and morphometric examinations showed no differences between the spinal cords from the rabbits injected with ketamine versus saline. Intrathecal ketamine produced motor impairment for a period of 15 min. We conclude that repeated intrathecal administration of preservative-free ketamine confirms the lack of neurotoxicity from single-dose studies.