Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialEvaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures.
Adequate postoperative analgesia without side effects is necessary to facilitate same-day discharge of ambulatory patients after ambulatory surgery. This study compared the use of intravenous morphine and fentanyl after painful ambulatory procedures with respect to analgesic efficacy, the incidence of side effects, and impact on the patient's readiness for discharge. Fifty-eight patients undergoing ambulatory surgery were prospectively randomized to receive morphine or fentanyl for postoperative analgesia and studied in double-blind fashion. ⋯ There was no significant difference in the duration of stay in the PACU (morphine vs fentanyl, 69 +/- 15 min vs 71 +/- 20 min), the times to achieve recovery milestones, and fitness for discharge (morphine vs fentanyl, 136 +/- 41 min vs 132 +/- 40 min). The short duration of fentanyl was not associated with faster discharge times; most patients required additional analgesia to control pain. Morphine produced a better quality of analgesia but was associated with an increased incidence of nausea and vomiting, the majority of which occurred after discharge.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialNitrous oxide does not increase vomiting after dental restorations in children.
The effect of nitrous oxide on postoperative vomiting was evaluated in 330 children who underwent outpatient dental restorations. There were two groups in this single-blind, randomized, controlled study. One group received nitrous oxide during their anesthetic, while the non-nitrous oxide group did not receive nitrous oxide at any time. ⋯ Overall, the incidence of vomiting was similar, with 30% of the control patients and 35% of the nitrous-treated patients vomiting after their anesthetic. However, in-hospital vomiting was less in the control group: 15% vs 24%, control versus nitrous oxide, P = 0.03. In conclusion, nitrous oxide does not alter postoperative vomiting after halothane anaesthesia for dental restorations in children.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialEffects of ketorolac versus bupivacaine coadministration during patient-controlled hydromorphone epidural analgesia after thoracotomy procedures.
We studied the comparative effects of ketorolac versus bupivacaine supplementation of hydromorphone (HM) patient-controlled epidural analgesia (PCEA) on the HM requirement, postoperative pain, and pulmonary function in 62 consenting patients after thoracotomy procedures. Patients were randomly assigned to receive one of three different combinations of analgesic medications after the operation according to a double-blind, placebo-controlled study. The treatment groups consisted of: Group 1 (n = 23): PCEA HM 3-mL (0.15 mg) bolus doses + saline 1 mL intravenously (IV) q6h, Group 2 (n = 20): PCEA HM (0.15 mg) in 0.125% bupivacaine 3-mL bolus doses + saline 1 mL IV q6h, and Group 3 (n = 19): PCEA HM 3-mL (0.15 mg) bolus doses + ketorolac 1 mL (30 mg) IV q6h. ⋯ Significant reductions in forced vital capacity, forced expiratory volume in 1 s, forced expiratory flow 25%-75% of the vital capacity, and peak expiratory flow rate (PEFR) were noted on PODs 1 and 2 in all three treatment groups. The decrease in PEFR on PODs 1 and 2 was significantly less with ketorolac compared with bupivacaine supplementation. We conclude that ketorolac supplementation of HM PCEA reduces the incidence of nonincisional pain and HM requirement compared with HM PCEA alone and may have a beneficial effect on pulmonary function compared with bupivacaine supplementation of HM PCEA in postthoracotomy patients.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialEpidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration.
Increased postoperative pain may be caused by central nervous system plasticity, which may be related to actions of N-methyl-D-aspartic acid (NMDA) receptors on neurons in the dorsal horn of the spinal cord. Opioids act mainly on presynaptic receptors and reduce neurotransmitter release, while ketamine antagonizes NMDA receptors and prevents wind-up and long-term potentiation. Thus, we postulated that central nervous system sensitization would be prevented more effectively by the preoperative use of these two drugs simultaneously, and the effect of preemptive analgesia would be demonstrated. ⋯ The duration of analgesia was longer (P < 0.01) in Group 1 (31.1 +/- 16.0 h) than in Group 2 (21.1 +/- 12.0 h), and the proportion of patients who needed supplemental injections was decreased (P < 0.05) in Group 1 (56.7%) compared with Group 2 (90.0%). The incidence of adverse effects was not different between the two groups. In conclusion, preoperative administration of morphine and ketamine is more effective in reducing postoperative pain than it is when given during the operation.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialDecreased mivacurium constant infusion requirements with defasciculating doses of pancuronium.
This study was designed to verify a technique in which the pharmacologic profile of mivacurium infusions could be altered by small doses of pancuronium to reduce the infusion requirement without altering the subsequent recovery kinetics. Thirty ASA physical status I or II patients were randomized into two groups in a blinded fashion. One group was administered pancuronium 10 micrograms/kg followed by pancuronium 2.5 micrograms.kg-1.h-1 thereafter. ⋯ The mivacurium infusion requirement for the group receiving the pancuronium supplementation was 2.77 +/- 1.38 micrograms.kg-1.min-1 (mean +/- SD), which represented a 49% decrease compared with the group that used mivacurium alone which required an infusion rate of 5.43 +/- 1.85 micrograms.kg-1.min-1. No statistically significant difference was found in the recovery profiles of the two groups when the infusion was terminated. We conclude that the addition of a small amount of pancuronium decreased the required mivacurium infusion rate by nearly 50% without affecting the spontaneous recovery when terminating the infusion.