Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 1998
Randomized Controlled Trial Clinical TrialIntravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy.
Postoperative ileus is a concern among surgical patients. Epidural anesthesia and analgesia with local anesthetics can decrease the duration of ileus. Significant systemic absorption of local anesthesia occurs during epidural use. In this study, we examined whether many of the beneficial effects on bowel function seen with epidural lidocaine are also present when the drug is given parenterally. Forty patients undergoing radical retropubic prostatectomy were studied with one half of the patients receiving a lidocaine bolus (1.5 mg/kg) and infusion (3 mg/min, unless weight <70 kg, then 2 mg/min); the other half received a saline infusion. A blind observer recorded the patient's daily pain score, the time the patient first experienced flatulence and had the first bowel movement, and the total use of analgesics. Lidocaine-treated patients first experienced flatulence in a significantly shorter time (P < 0.01) than control patients. Lidocaine patients' hospital stay was also significantly shorter (P < 0.05); on average, they spent 1.1 fewer days in the hospital. I.V. lidocaine initiated before anesthesia and continued 1 h postoperatively significantly sped up the return of bowel function. Lidocaine patients were also more comfortable postoperatively. Many of the bowel function benefits attributed to epidural lidocaine are also present when the drug is administered parenterally. Additionally, the length of hospital stay was reduced in lidocaine-treated patients. ⋯ This study prospectively examined whether I.V. lidocaine could affect the return of bowel function after radical prostate surgery. Lidocaine-treated patients had shorter hospital stays, less pain, and faster return of bowel function. In this population, lidocaine infusion can be a useful adjunct in anesthetic management.
-
Anesthesia and analgesia · Feb 1998
Randomized Controlled Trial Clinical TrialSubhypnotic doses of propofol do not relieve pruritus induced by intrathecal morphine after cesarean section.
The purpose of this study was to determine whether subhypnotic doses of propofol effectively relieve pruritus in women who received intrathecal morphine for postoperative analgesia after cesarean delivery. Twenty-nine women who developed pruritus after undergoing an elective cesarean section and receiving intrathecal morphine (0.25 mg) for postoperative analgesia were enrolled in this randomized, prospective, double-blind study. The women were randomly assigned to receive either 1 mL of propofol (n = 17) or 1 mL of placebo (n = 12) I.V. Pruritus was evaluated 5 min after treatment. In the absence of successful treatment, the women received another 1 mL of the same drug. Pruritus was again evaluated 5 min after the second dose. We found that pruritus was successfully treated twice in the propofol group and once in the placebo group (P = not significant). The antipruritic action of propofol lasted for up to 6 h in one woman and 15 min in the other. The one success in the placebo group lasted for 15 min. We conclude that the success rate of propofol in treating pruritus in women who received intrathecal morphine for postoperative analgesia after cesarean delivery is not significantly different from that of placebo. ⋯ Pruritus is a common and bothersome side effect of neuraxial opioids after cesarean section. Subhypnotic doses of I.V. propofol (10 mg) have been used to treat pruritus caused by neuraxial opioids. In this prospective, randomized, double-blind study, we found that propofol does not relieve pruritus in women who underwent cesarean section and received intrathecal morphine sulfate (0.25 mg) for postoperative pain relief.
-
Anesthesia and analgesia · Feb 1998
Randomized Controlled Trial Clinical TrialIntraarticular morphine in the multimodal analgesic management of postoperative pain after ambulatory anterior cruciate ligament repair.
Reconstruction of the anterior cruciate ligament (ACL) is associated with a considerable degree of postoperative pain. Our customary multimodal approach to postoperative analgesia after ambulatory ACL surgery includes perioperative nonsteroidal antiinflammatory drugs, pre- and postincisional intraarticular (I.A.) bupivacaine (B), and postoperative cryotherapy using an external cooling system. This study was designed to determine whether the addition of I.A. morphine (MS) provides improved postoperative analgesia. One hundred patients scheduled for elective ambulatory ACL repair received our standard multimodal therapy. After surgery, patients were randomized to one of four study groups. Group 1 received 30 mL of 0.25% B I.A. Group 2 received 30 mL of normal saline I.A. and 5 mg of MS I.A. Group 3 received 30 mL of 0.25% bupivacaine I.A. and 5 mg of MS I.V.. Group 4 received 30 mL of 0.25% B I.A. and 5 mg of MS I.A. The addition of I.A. B postoperatively provided prolonged analgesia and decreased postoperative pain and analgesic requirements. The addition of MS to I.A. B did not provide additional postoperative analgesia. We conclude that patients undergoing ambulatory ACL repair using our standard multimodal analgesic regimen failed to receive additional postoperative analgesia when MS was added to the I.A. B. ⋯ Patients receiving a multimodal analgesic regimen of perioperative nonsteroidal antiinflammatory drugs, intraarticular bupivacaine, and external cooling did not receive any additional analgesia from intraarticular morphine.
-
Anesthesia and analgesia · Feb 1998
Randomized Controlled Trial Clinical TrialThe analgesic effect of fentanyl, morphine, meperidine, and lidocaine in the peripheral veins: a comparative study.
Using venous retention with a tourniquet (70 mm Hg), we performed a randomized, double-blind study to assess the efficacy of I.V. pretreatment with fentanyl, morphine, meperidine, or lidocaine in reducing propofol injection pain. Immediately after venous occlusion with a tourniquet, I.V. fentanyl 150 microg (Group A, n = 35), morphine 4 mg (Group B, n = 35), meperidine 40 mg (Group C, n = 35), 2% lidocaine 3 mL (Group D, n = 35), or normal saline 3 mL (Group E, n = 35; as placebo control) was given to adult patients. The venous retention of the drug was maintained for 1 min, followed by tourniquet release and I.V. administration of propofol 100 mg. Pain assessment was made immediately after the propofol injection. Lidocaine and meperidine significantly reduced propofol injection pain more than placebo (P < 0.05), but there were more side effects in the meperidine group. Fentanyl and morphine reduced the intensity of propofol injection pain (P < 0.05) and had some effect in reducing the incidence of propofol injection pain, but the difference did not reach statistical significance. The order of efficacy was lidocaine approximately meperidine > morphine approximately fentanyl. We postulate that the peripheral analgesic effect of these opioid is due to their local anesthetic activity. ⋯ Propofol, a commonly used anesthetic, often causes pain on injection. Given as venous retention pretreatments 1 min before propofol, meperidine and lidocaine were found to significantly reduce the propofol injection pain, whereas fentanyl and morphine only slightly reduced the propofol injection pain.
-
Anesthesia and analgesia · Feb 1998
A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy.
This two-armed study was designed to determine whether recovery after esophageal resection may be improved by introducing a new multimodal approach. For 8 mo after the new approach was introduced, all patients undergoing abdominothoracic esophageal resection were studied (Group 2; n = 42). For comparison, a retrospective analysis was also conducted using the data of all patients who had undergone this operation in the 8 mo before the introduction of the new regimen, when the traditional therapy was still in use (Group 1; n = 49). All patients received an epidural catheter at the level of T6-9 before the induction of general analgesia. Afterward, Group 1 patients were operated under general anesthesia. For postoperative pain relief, a mixture of bupivacaine 1.25 mg/mL and sufentanil 1 microg/mL was administered during 5 days without titration of the quality of analgesia. Patients in Group 2 received a preoperative bolus of 10-15 mL bupivacaine 2.5 mg/mL and 20-30 microg sufentanil. After sensory block up to T4 was confirmed, general anesthesia was introduced and intraoperatively combined with a continuous infusion of 5 mL/h of a solution containing bupivacaine 1.75 mg/mL and sufentanil 1 microg/mL. Postoperatively, the epidural infusion rate was adjusted to the need of the individual patients, who were able to administer themselves additional bolus doses of 2 mL with a lockout time of 20 min. Early tracheal extubation and forced mobilization were pursued to improve recovery. Demographic data of both groups were comparable. The pain relief of Group 2 patients was superior to that of patients in Group 1. The nitrogen balance of a subgroup of nine matched pairs of patients with comparable nutritional status was less negative in Group 2 patients on Postoperative Days 1 and 2. Patients in Group 2 were tracheally extubated earlier (mean 6.7 vs 25.1 h after admission to the intensive care unit [ICU]), mobilized earlier (mean 1.2 vs 2.0 days after surgery), discharged from the ICU earlier (mean 1.7 vs 4.0 days), and fulfilled criteria for discharge from the ICU (mean 1.8 vs 4.1 days) and from the intermediate care unit earlier (4.9 vs 6.4 days). We conclude that the multimodal approach may improve recovery and thus reduce costs after abdominothoracic esophageal resection. ⋯ Analgesia and blockade of the perioperative stress response, combined with other aspects of postoperative therapy, may improve recovery after surgery. The intensive care unit stay after esophageal resection was reduced by a new regimen (thoracic epidural analgesia, early tracheal extubation, forced mobilization). This approach may influence the cost of major surgery.