Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialEquivalent outcomes during postoperative patient-controlled intravenous analgesia with lidocaine plus morphine versus morphine alone.
To evaluate a possible opioid-sparing effect of intravenous lidocaine we conducted a randomized, double-blind clinical trial. Patients undergoing intraabdominal surgery under general anesthesia were treated with patient-controlled analgesia (PCA) in three groups: Group 1 (n = 100; morphine 1 mg/mL), Group 2 (n = 44; morphine 1 mg/mL plus lidocaine 10 mg/mL), and Group 3 (n = 51; morphine 1 mg/mL plus lidocaine 20 mg/mL). Pain was evaluated using a 0-10 visual analog scale in the postanesthesia care unit (PACU) during deep inhalation at 15 and 30 min, and at 1, 2, and 4 h after arrival in the PACU, and continued after PACU discharge every 4 h for 36 h. ⋯ Along with pain intensity, we assessed vital signs and side effects. Time to acceptance of oral liquids was also determined. Adding lidocaine 10 or 20 mg/mL to PCA morphine 1 mg/mL for acute pain treatment after abdominal surgery yielded no differences in opioid use, pain levels, or side effects.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine.
The purpose of this study was to compare meperidine to meperidine with bupivacaine when used for patient-controlled epidural analgesia (PCEA) after thoracotomy. For 3 days after thoracotomy patients received thoracic PCEA with meperidine 0.1% plain or with added bupivacaine 0.1% or 0.01%. No background infusion was used. ⋯ The addition of bupivacaine 0.1% reduced the incidence of pruritus (P = 0.036), but 5 of 23 patients in this group were with-drawn from the study because of significant hypotension, oliguria, and/or motor or sensory block (P = 0.006). We conclude that the addition of bupivacaine 0.1% or 0.01% to thoracic PCEA meperidine 0.1% does not affect meperidine requirements or analgesia after thoracotomy. The addition of bupivacaine 0.1% may reduce pruritus, but is associated with signs of excessive sensory, motor, or autonomic blockade in a significant number of patients.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialCombination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting.
The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. ⋯ A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.
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Anesthesia and analgesia · Jul 1996
Preoperative fasting time: is the traditional policy changing? Results of a national survey.
Several papers in the 1980s questioned the wisdom of withholding clear liquids for more than 3 h before elective surgery. Furthermore, recent papers have suggested relaxing the current NPO after midnight (Latin: Nulla per os; or "nothing by mouth") practice in children and adults. To see whether the policy and practice regarding NPO status before elective surgery have changed in the United States, we performed a national survey. ⋯ In conclusion, our survey revealed that 69% of anesthesiologists in the United States have either changed their NPO policy or are flexible in their practice in allowing clear liquids before elective operation in children and 41% have done so for adult patients. The most frequently allowed clear liquids in the adult and pediatric population were water and apple juice. None of the respondents reported any medical adverse event associated with the institution of a flexible NPO policy.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialSustained-release ibuprofen as an adjunct to morphine patient-controlled analgesia.
Previous studies have demonstrated reduced postoperative morphine requirements and/or improved pain relief when nonsteroidal antiinflammatory drugs are administered in conjunction with patient-controlled analgesia (PCA). This double-blind study aimed to determine whether these effects could be obtained with a sustained-release ibuprofen formulation (Brufen Retard) given preoperatively, obviating the need for oral administration during the early postoperative period. We aimed also to determine whether the anticipated reduction in morphine requirements was associated with reduced opioid side effects. ⋯ Morphine consumption was slightly but not significantly lower in the ibuprofen group (32 vs 38 mg/24 h, P = 0.096). Spo2 (P = 0.54), level of consciousness (P = 0.65), and number of antiemetic administrations (P = 0.15) did not differ significantly between groups. These results demonstrate improved efficacy with no increase in side effects when sustained-release ibuprofen is used as an adjunct to morphine PCA.