Anesthesia and analgesia
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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
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.
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Anesthesia and analgesia · Jul 1996
Case ReportsTransient compartment syndrome of the forearm after attempted radial artery cannulation.
Radial artery cannulation for continuous intraoperative monitoring of arterial blood pressure is considered a safe procedure. One complication of arterial cannulation is hematoma formation at the time of insertion or removal of the catheter. Bleeding is usually self-limited or will stop with compression without significant sequelae, even in the anticoagulated patient. We describe a case of hematoma with a transient compartment syndrome of the forearm after attempts to cannulate the radial artery for intraoperative monitoring purposes.
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Anesthesia and analgesia · Jul 1996
The effects of intrathecally administered FK480, a cholecystokinin-A receptor antagonist, and YM022, a cholecystokinin-B receptor antagonist, on the formalin test in the rat.
Cholecystokinin (CCK) is located in the brain and the spinal cord, and CCK antagonist is reported to enhance the analgesic effect of morphine. It has been suggested that, during inflammation, the level of endogenous opioid peptides increases in the spinal cord. Intrathecally administered CCK antagonist may have some analgesic effect during inflammation via the activated spinal opioid system. ⋯ Pretreatment, but not posttreatment, with YM022 depressed the Phase 1 and Phase 2 flinching behavior in a dose-dependent manner, and this YM022 effect was stereospecific and was not antagonized by naloxone. These data indicate that a CCK-B receptor antagonist, but not a CCK-A receptor antagonist, produces an antinociceptive effect in the rat formalin test. This effect of a CCK-B receptor antagonist was not mediated by the spinal opioid receptor activation.