Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialMorphine patient-controlled analgesia is superior to meperidine patient-controlled analgesia for postoperative pain.
The choice between morphine and meperidine for postoperative pain is usually based on the preference of the prescriber, as few objective comparative data are available. This blind, randomized study compared the efficacy and side effects of morphine and meperidine administered by patient-controlled analgesia (PCA) for postoperative pain. One hundred two consenting patients scheduled for major abdominal surgery were randomly assigned to receive PCA with morphine (0.75, 1.0, or 1.5 mg bolus dose size) or meperidine (9, 12, or 18 mg) for pain control. ⋯ Meperidine use was associated with poorer performance in the trailmaking tests and a greater incidence of dryness of the mouth. Severity of nausea, mood, and incidence of unusual dreams did not differ significantly between drugs. We conclude that meperidine should be reserved for those patients in whom morphine is judged inappropriate.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialThe addition of continuous intravenous infusion of ketorolac to a patient-controlled analgetic morphine regime reduced postoperative myocardial ischemia in patients undergoing elective total hip or knee arthroplasty.
This double-blind randomized trial assessed the effect of adding an intravenous continuous infusion of ketorolac to a patient-controlled analgesia (PCA) morphine regimen on analgesia, heart rate, arterial blood pressure, and postoperative myocardial ischemia. Patients having elective total hip or knee replacement were randomized to receive ketorolac 30 mg bolus, followed by an infusion of 5 mg/h for 24 h or placebo. All patients had access to PCA morphine (20 microg/kg bolus, with a lockout of 6 min). ⋯ All ST depressions were clinically silent. Logistic regression of factors predicting ischemia included the use of calcium channel blockers and low pain score. These results suggest that analgesia with ketorolac reduces the duration of ischemic episodes in the first 24 h postoperatively.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialThe efficacy of epinephrine test doses during spinal anesthesia in volunteers: implications for combined spinal-epidural anesthesia.
Epinephrine test doses may be administered during combined spinal-epidural anesthesia to determine intravascular placement of epidural catheters. This study was designed to determine systolic blood pressure (SBP) and heart rate (HR) responses to intravenous injection of epinephrine (15 microg) during spinal anesthesia. Twelve volunteers received three spinal anesthetics (lidocaine 100 mg, tetracaine 15 mg, and bupivacaine 15 mg) in a randomized, double blind, cross-over fashion. ⋯ Peak HR responses decreased by 11 bpm during all three spinal anesthetics (P < 0.05). Incidences of detection of intravenous injection by positive SBP and HR responses ranged from 50% to 100% and were not significantly affected by spinal anesthesia. Spinal anesthesia reduces hemodynamic responses to intravenous epinephrine injection but is unlikely to reduce detection by positive SBP and HR criteria.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialFemoral and genitofemoral nerve blocks versus spinal anesthesia for outpatients undergoing long saphenous vein stripping surgery.
Long saphenous vein stripping (LSVS) surgery is often used to treat varicose veins. We tested the hypothesis that femoral nerve block (FNB) with genitofemoral nerve infiltration provides sufficient analgesia and superior recovery characteristics to spinal anesthesia for LSVS procedures in the ambulatory setting. Thirty-six patients were randomized to receive FNB with 30 mL of 3% alkalinized chloroprocaine, and 32 patients received spinal anesthesia with 65 mg of 5% hyperbaric lidocaine. ⋯ Patients in the FNB group had significantly faster recovery (P < 0.01) and lower incidences of pain (P < 0.05) and complications (P < 0.05) than the patients in the spinal group. All patients who received FNB indicated that they would choose this type of anesthesia in the future, whereas five (15%) patients in the spinal group would refuse spinal anesthesia in the future (P < 0.01). We conclude that FNB is an excellent anesthetic choice for LSVS.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialThe use of 0.25% lidocaine with fentanyl and pancuronium for intravenous regional anesthesia.
The present study was designed to assess the efficacy of fentanyl and pancuronium combined with dilute lidocaine solution for intravenous regional anesthesia of the arm. Forty adult patients undergoing upper limb surgery were randomly allocated to receive either 0.6 mL/kg of 0.5% lidocaine (3 mg/kg) or 0.6 mL/kg of 0.25% lidocaine (1.5 mg/kg) with 1 microg/kg of fentanyl and 0.5 mg of pancuronium. The onset of sensory and motor blocks was significantly shorter in the 0.5% lidocaine group (P < 0.05). ⋯ One patient in the 0.25% lidocaine group experienced a transient diplopia after tourniquet release. Postoperative analgesia time was similar in the two groups. We conclude that the addition of fentanyl plus pancuronium to the lidocaine solution reduces the dose of the local anesthetic and possibly systemic toxicity.