Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialRecovery from outpatient laparoscopic tubal ligation is not improved by preoperative administration of ketorolac or ibuprofen.
The analgesic efficacy of a single dose of ketorolac or ibuprofen given preoperatively was assessed in healthy outpatients undergoing general anesthesia for laparoscopic tubal ligation. Fifty patients were randomized to receive either ketorolac 60 mg intravenously (i.v.), ibuprofen 800 mg orally, or placebo in a double-blind manner. Anesthesia was induced with fentanyl 2 micrograms/kg, thiopental 5 mg/kg, and either vecuronium 0.1 mg/kg or succinylcholine 1.5 mg/kg i.v. and was maintained with nitrous oxide 67% in oxygen and isoflurane. ⋯ The dose of parenteral morphine required in the PACU was not different between the control (7 +/- 1.2 mg), ibuprofen (5.7 +/- 1.4 mg), and ketorolac (6.1 +/- 1.4 mg) groups. There was no difference between groups in terms of pain visual analog scale (VAS) scores, fatigue VAS scores, recovery times, or the incidence of postoperative nausea and vomiting. The preoperative administration of either parenteral ketorolac or oral ibuprofen did not decrease postoperative pain or side effects when compared to placebo in this outpatient population.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialAn isobolographic study of epidural clonidine and fentanyl after cesarean section.
Although the epidural administration of clonidine and fentanyl provides pain relief after surgery, the interaction between the two drugs has not been examined formally. This study used an isobolographic method to determine whether epidurally administered fentanyl and clonidine interact in an additive or synergistic manner. Ninety women with moderate to severe pain after elective cesarean section under epidural anesthesia were studied. ⋯ Unlike studies in rodents, this clinical study did not demonstrate synergy between fentanyl and clonidine. This could reflect a true species difference or differences in methodologies used. Nonetheless, a reduced dose of fentanyl and clonidine can be combined for excellent analgesia.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialSubcutaneously versus subfascially administered lidocaine in pain treatment after inguinal herniotomy.
We conducted a randomized, prospective, double-blind trial to compare the efficacy of subfascial (SF) versus subcutaneous (SC) lidocaine (10 mL 1%) given in the wound postoperatively through a catheter placed in the respective layer intraoperatively. The initial pain scores were similar in the two groups before injection of lidocaine. ⋯ Supplemental analgesics after the lidocaine administration were needed earlier in the SC group than in the SF group (P < 0.01). We conclude that postoperative pain treatment with local lidocaine application after herniotomy has a better effect when applied in the SF, rather than the SC, layer.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialPreoperative analgesia with epidural morphine.
In a prospective double-blind study, we examined the effects of preoperative epidural morphine associated with general anesthesia (GA) on intra- and postoperative analgesic requirements over a 3-day postoperative period. Twenty patients scheduled for major intraabdominal surgery were randomly assigned to two groups: a control group (n = 10) and an epidural group (n = 10) which received an epidural injection of 5 mg of preservative-free morphine in 10 mL of 0.9% saline. Afterward, both groups received the same GA. ⋯ The consumption of IV morphine by the control group decreased over time (P < 0.001, r = 0.44), whereas, in the epidural group, consumption remained constant and small during the 3 days. The maximum pain score was significantly lower in the epidural group than in the control group at 24 h (0.65 +/- 2.4 vs 3 +/- 2), at 36 h (0.3 +/- 0.6 vs 3 +/- 2.7), and at 60 h (0.1 +/- 0.3 vs 1.8 +/- 1.2) after surgery. These results suggest that a single epidural injection of 5 mg of morphine before major surgery produces intra- and postoperative pain relief for at least 3 days.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialEffectiveness of low levels of nonventilated lung continuous positive airway pressure in improving arterial oxygenation during one-lung ventilation.
Continuous positive airway pressure (CPAP) of 5 and 10 cm H2O applied to the nonventilated lung is effective in improving arterial oxygenation during one-lung ventilation (1-LV). The effectiveness of lower levels of CPAP on improving oxygenation, however, has not been reported, possibly because of limitations of previous methods of CPAP delivery. Recently, a disposable, self-assembled CPAP system capable of delivering CPAP over a wide range of pressures has been introduced (Mallinckrodt Medical, Inc., St. ⋯ Application of CPAP followed 20 min of stable 1-LV in the lateral decubitus position. Compared with two-lung ventilation, PaO2 (mean +/- SD) was significantly less with 1-LV (Group I, 126 +/- 75 mm Hg, and Group II, 173 +/- 79 mm Hg). Application of the assigned CPAP resulted in an increase in PaO2 compared to 1-LV (Group I, 270 +/- 112 mm Hg, and Group II, 386 +/- 66 mm Hg; P < or = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)