Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialIntrathecal sufentanil for labor analgesia: do sensory changes predict better analgesia and greater hypotension?
Sensory changes and hypotension occur after intrathecal sufentanil (ITS) is given during labor. The goal of this study was to determine whether sensory changes are predictive of hemodynamic changes or duration of pain relief. We also examined whether sensory and hemodynamic changes relate to the concentration of ITS administered. ⋯ Systolic blood pressure decreased 23 +/- 2 mm Hg (P < 0.05) during the first 30 min after ITS, and six patients were given ephedrine. The magnitude of blood pressure change was not affected by the diluent volume or the presence of sensory changes. Because sensory changes were not predictive of the duration or quality of analgesia or the degree of hemodynamic change, we conclude that analgesia with ITS is predominantly mediated via spinal cord opioid receptors rather than by a local anesthetic-type conduction blockade.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialAcupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.
Nausea and vomiting occur frequently during cesarean section under spinal anesthesia. Metoclopramide reduces intraoperative nausea and vomiting, but not without potential side effects. Acupressure, a noninvasive variation of acupuncture that involves constant pressure on the wrist, has been suggested as an alternative method to prevent nausea and vomiting. ⋯ Group I patients received acupressure bands + 2 mLIV saline, Group II patients received placebo wrist bands + 10 mg IV metoclopramide, and Group III patients received placebo wrist bands + 2 mL IV saline. Patients who received either acupressure or metoclopramide prior to initiation of spinal anesthesia for cesarean section had much less nausea than patients in the placebo group. Acupressure is an effective, non-pharmacologic method to reduce intraoperative nausea during elective cesarean section in the awake patient.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Multicenter Study Clinical TrialIntravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery.
The newer 5-hydroxytryptamine type 3 (5-HT3) antagonists are sometimes considered for routine prophylaxis of postoperative nausea and vomiting (PONV) in high-risk patients. This multicenter, randomized, double-blind, placebo-controlled study compared the efficacy and safety of three single intravenous (IV) doses of dolasetron mesylate salt (12.5, 25, or 50 mg) for the prevention of PONV in 635 females undergoing outpatient laparoscopic gynecologic surgery. Antiemetic efficacy was evaluated over a 24-h postoperative period by recording the number and timing of emetic episodes; effects on nausea were evaluated by a visual analog scale (VAS). ⋯ Dolasetron-treated patients had significantly (P < 0.0357) lower median postdose maximum nausea VAS scores compared with placebo-treated patients. Patient satisfaction with dolasetron was high and, overall, was significantly (P = 0.0131) greater than that with placebo. Dolasetron was an effective and well tolerated preventive treatment for PONV resulting from laparoscopic gynecologic surgery.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialEpidural dexamethasone reduces the incidence of backache after lumbar epidural anesthesia.
We performed a prospective, randomized, double-blind study to compare the effect of epidural dexamethasone on the incidence of postepidural backache after nonobstetric surgery. One thousand unpremedicated ASA physical status I or II patients scheduled for hemorrhoidectomy were randomly assigned to two groups: Group I patients received 25 mL 2% lidocaine with epinephrine 1:200,000 and 1 mL dexamethasone (5 mg) epidurally. Patients were interviewed at 24,48, and 72 h postoperatively using a standard visual analog scale (VAS) for evaluation of postepidural backache. ⋯ The severity and duration of postepidural backache were also significantly decreased in Group II patients. In our study, there was a significant association between postepidural backache and multiple attempts at epidural needle insertion. In summary, epidural dexamethasone reduced the incidence and severity of postepidural backache.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialHands-up positioning during asymmetric sternal retraction for internal mammary artery harvest: a possible method to reduce brachial plexus injury.
This study compares the hands-up (HU) with the arms at side (AAS) position to determine whether one is beneficial in reducing brachial plexus stress during asymmetric sternal retraction. Eighty patients undergoing cardiac surgery were assigned to either Group 1 (AAS) or Group 2 (HU). Perioperative neurologic evaluations of the brachial plexus were performed and somatosensory evoked potentials (SSEPs) were collected during internal mammary artery harvest using asymmetric sternal retraction. ⋯ During asymmetric sternal retraction, HU positioning offered minimal benefit in reducing brachial plexus stress as measured by SSEP. Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury. However, none of the four patients with plexus symptoms in the HU group had ulnar nerve problems, suggesting that the higher incidence of postoperative symptoms observed with AAS positioning may occur from ulnar nerve compression.