Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Clinical TrialSystemic adenosine infusion alleviates spontaneous and stimulus evoked pain in patients with peripheral neuropathic pain.
In seven patients with peripheral neuropathic pain, the effect of systemic adenosine infusion on pain symptoms was evaluated in a double-blind, placebo controlled, cross-over study. The study infusions, adenosine (50 micrograms.kg-1.min-1) or placebo, were given intravenously (IV) during 45-60 min at two separate occasions. Before and during infusions, bedside examination of sensibility and quantitative sensory testing (QST), i.e., assessments of perception thresholds for touch, touch-evoked pain, cold, warmth, painful heat, and cold, were performed. ⋯ Pinprick-evoked pain in the neuropathic areas was reduced from 53 +/- 11 to 29 +/- 10 mm (P < 0.05). No other sensory modality was consistently changed during adenosine infusion. In conclusion, the present study demonstrates that adenosine infusion alleviates spontaneous neuropathic pain, tactile allodynia, and pinprick hyperalgesia in patients with peripheral neuropathic disorders, probably by a central mechanism of action.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialComputer-controlled infusion of alfentanil versus patient-controlled administration of morphine for postoperative analgesia: a double-blind randomized trial.
This study compared the efficacy of computer-controlled infusion of alfentanil (CCiA) with patient-controlled administration of morphine (PCAM) for postoperative analgesia. Twenty patients were randomly allocated to one of the two study groups to receive either an intravenous CCiA or PCAM regimen. Pain scores measured on a visual analog scale (VAS) and the number of valid demands were used as variables to evaluate the efficacy of the postoperative analgesic therapy. ⋯ The MDPE and MDAPE were 8% and 22%, respectively. The maximum alfentanil concentrations associated with pain and the minimum effective analgesic concentrations of alfentanil varied considerably both inter- and intraindividually. In conclusion, compared to a standard intravenous PCAM regimen, a CCiA is faster in onset of analgesia and is as effective in providing postoperative analgesia.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Clinical TrialA new axillary approach for continuous brachial plexus block. A clinical and anatomic study.
Catheter insertion in the neurovascular space by axillary approach allows a continuous brachial plexus block and/or postoperative analgesia. We developed a perivenous technique whereby the approach to the neurovascular sheath is guided under fluoroscopy by a preopacified axillary vein. A randomized study compared this technique to the technique of Selander in ASA grade I-II patients scheduled for surgery or painful physiotherapy of the hand. ⋯ The concentrations were higher (P < 0.01) in failed blocks; the median value was 1.69 micrograms/mL (95% confidence interval: 0.58-2.8). A complementary anatomic study of three arms from fresh cadavers allowed verification of the correct localization of the Teflon cannula and flexible catheter, as well as homogeneous diffusion of the methylene blue inside the brachial plexus. The perivenous technique for continuous axillary brachial plexus block may improve the success rate due to its radiologic and accurate location of the neurovascular sheath.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane for outpatient anesthesia: a comparison with propofol.
Three different anesthetic techniques were compared in 146 healthy outpatients undergoing ambulatory surgery. In Groups I and II, anesthesia was induced with propofol (1.5-2.0 mg/kg, intravenously [iv]) and maintained with nitrous oxide (N2O) 60% in oxygen and either a propofol infusion, 75-160 micrograms.kg-1.min-1 IV, or sevoflurane, 1%-2% end-tidal, respectively. In Group III, anesthesia was induced and maintained with sevoflurane, 1%-4% end-tidal and N2O 60% in oxygen. ⋯ The use of sevoflurane for induction and/or maintenance of anesthesia was associated with a higher incidence of postoperative emetic sequelae compared with propofol. Finally, the times at which patients were considered "fit for discharge" and the actual discharge times were similar in all three groups. Sevoflurane is an acceptable alternative to propofol for induction and maintenance of outpatient anesthesia.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 5% with dextrose, 1.5% with dextrose, and 1.5% dextrose-free lidocaine solutions for spinal anesthesia in human volunteers.
The use of lidocaine in concentrations less than 5% for spinal anesthesia may be advantageous but has not been carefully studied. Lidocaine 50 mg (1.5% with dextrose and 1.5% dextrose-free) was administered to eight volunteers in a randomized, double blind, cross-over fashion. All of these subjects had previously received 5% lidocaine with dextrose using the same experimental protocol. ⋯ Duration of motor block was increased (45 +/- 9 min) with the 5% and the 1.5% without dextrose solutions (P < 0.04). Time to void was increased (33 +/- 5 min) with the 5% solution (P < 0.03). In conclusion, the use of different solutions of lidocaine for spinal anesthesia results in significant differences in sensory and motor block and time until recovery of micturition.