Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2002
Randomized Controlled Trial Comparative Study Clinical TrialMinidose lidocaine-fentanyl spinal anesthesia in ambulatory surgery: prophylactic nalbuphine versus nalbuphine plus droperidol.
Minidose lidocaine-fentanyl spinal anesthesia (SAB(MLF)) is a safe, effective, and efficient anesthetic for ambulatory surgery. Unfortunately, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. Nalbuphine is effective in treating or preventing pruritus after intrathecal or epidural morphine but may or may not have a beneficial effect on nausea and vomiting. Droperidol has demonstrated antiemetic efficacy with neuraxial opiates. In this study, we examined the prophylactic use of nalbuphine alone compared with nalbuphine with droperidol after SAB(MLF). One-hundred-twenty-four patients having outpatient knee arthroscopy under SAB(MLF) with 20 mg of lidocaine 0.5% and 20 micro g of fentanyl were randomized to receive IV at the end of surgery either 4 mg of nalbuphine (Group N) or droperidol 0.625 mg plus nalbuphine 4 mg (Group ND). The incidences of early (before discharge) and late onset nausea were, respectively, 18% versus 5% and 32% versus 13%. The postoperative incidences of pruritus were 61% versus 40%, whereas 19% of patients in Group N compared with 2% of patients in Group ND requested treatment for this. Group ND had lower pain scores and had a longer delay until first use of analgesic. There were no differences in average times to discharge. The only side effect of the medications was an increased drowsiness in Group ND. In conclusion, as prophylactic medication for use in conjunction with SAB(MLF), the addition of droperidol 0.625 mg to nalbuphine 4 mg was superior to nalbuphine alone. The combination provided for reduced postoperative nausea, pruritus, and pain-benefits that persisted after discharge home. The combination also avoided isolated cases of extreme delay in discharge. ⋯ Droperidol in combination with nalbuphine enhances analgesia and is more effective than nalbuphine alone in preventing pruritus, nausea, and vomiting after minidose lidocaine-fentanyl spinal anesthesia.
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Anesthesia and analgesia · Dec 2002
Randomized Controlled Trial Clinical TrialProphylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritus.
We investigated the effectiveness of prophylactic IV ondansetron in preventing intrathecal fentanyl-induced pruritus. One-hundred-fifty ASA status I-II patients undergoing spinal anesthesia with 7-10 mg of hyperbaric bupivacaine and 25 micro g of fentanyl were randomized to receive ondansetron 8 mg IV or normal saline IV before the commencement of spinal anesthesia. Evaluations were performed every 15 min in the first hour after the injection of study drugs and at 1, 2, 3, 4, 5, and 6 h after the administration of the study drug. Statistical analysis was performed by using chi(2) tests and Student's t-test, as appropriate. The incidence of pruritus was significantly more frequent in the placebo group compared with the ondansetron group (68% versus 39%) (P = 0.001). Time to pruritus was similar in both groups (placebo group, 55 +/- 32 min versus ondansetron group, 50 +/- 31 min). Duration of pruritus was also similar in both groups (placebo group, 98 +/- 60 min versus ondansetron group, 103 +/- 58 min). Ondansetron prophylaxis significantly reduced the incidence of intrathecal fentanyl-induced pruritus in patients undergoing surgery under bupivacaine spinal anesthesia. ⋯ Pruritus is a commonly reported side effect after intrathecal fentanyl administration during spinal anesthesia. This study was performed in a prospective, randomized, double-blinded, placebo-controlled manner to investigate the efficacy of prophylactic IV ondansetron in the prevention of pruritus after intrathecal fentanyl administration during spinal anesthesia. The incidence of pruritus was significantly more frequent in the placebo group compared with the ondansetron group (68% versus 39%) (P = 0.001).
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Anesthesia and analgesia · Dec 2002
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of ketamine and lidocaine spray with propofol for the insertion of laryngeal mask airway in children: a double-blinded randomized trial.
The laryngeal mask airway (LMA) has been used successfully as both a ventilatory device and a conduit for tracheal intubation. In this double-blinded, randomized study, we examined whether pretreatment with lidocaine spray, ketamine anesthesia, and LMA insertion could be used as airway management that could maintain spontaneous breathing in children. After IV premedication with midazolam 0.05 mg/kg and glycopyrrolate 0.005 mg/kg, 90 patients were randomly allocated to 1 of 2 main groups for the administration of either propofol or ketamine: 40 patients received 2.5, 3.0, 3.5, or 4.0 mg/kg of propofol IV (n = 10 each), whereas 50 patients received 2.0, 2.5, 3.0, 3.5, or 4.0 mg/kg of ketamine IV (n = 10 each). Only in the ketamine group was lidocaine spray applied to the oropharynx 1 min before anesthesia induction. After injection of the designated drug, self-respiration, airway obstruction, and jaw relaxation were checked. Self-respiration, laryngospasm coughing, gagging, swallowing, biting or tongue movements, secretions, and head or limb movements after LMA insertion were graded. All variables were graded as satisfactory, acceptable, or unsatisfactory. The overall result was considered satisfactory if all criteria were satisfactory; acceptable if all were better than acceptable, but at least one acceptable criterion was included; and unsatisfactory if at least one criterion was unsatisfactory. Overall satisfactory or acceptable results in every patient were achieved only in the ketamine 3.0 or 3.5 mg/kg subgroups. No propofol dose was completely satisfactory; most cases involved apnea or airway obstruction. Ketamine and lidocaine spray were appropriate for LMA insertion, which may be a safe method for management of difficult airway in children. ⋯ Ketamine and lidocaine spray appear to be appropriate for laryngeal mask airway (LMA) insertion in children. Thus, apnea and airway obstruction, the two most serious and frequent complications of propofol, can be avoided during LMA insertion.
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Anesthesia and analgesia · Dec 2002
Randomized Controlled Trial Clinical TrialEpidural morphine and neostigmine for postoperative analgesia after orthopedic surgery.
In this study, we examined the side effects and analgesia of the combination of epidural neostigmine and morphine in patients undergoing orthopedic surgery. Sixty patients undergoing knee surgery were divided into four groups. The intrathecal anesthetic was 15 mg of bupivacaine. The epidural test drug was diluted in saline to a final volume of 10 mL. The control group received saline as the epidural test drug. The morphine group received 0.6 mg of epidural morphine. The neostigmine group (NG) received 60 micro g of epidural neostigmine. The morphine/neostigmine group received 0.6 mg of epidural morphine combined with 60 micro g of epidural neostigmine. The groups were demographically the same and did not differ in intraoperative characteristics. The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among groups (P > 0.05). One patient from the NG complained of intraoperative nausea, closely related to spinal hypotension. Postoperatively, two patients from the NG had vomited once. The time (min) to first rescue analgesic was longer in the morphine/neostigmine group ( approximately 11 h) compared with the other groups (P < 0.05). The analgesic consumption (number of analgesic administrations in 24 h) was larger in the control group compared with the other groups (P < 0.05). ⋯ The combination of epidural morphine and epidural neostigmine resulted in postoperative analgesia (11 h) devoid of side effects, being an alternative analgesic technique in the population studied.
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Anesthesia and analgesia · Dec 2002
Randomized Controlled Trial Clinical TrialThe addition of a tramadol infusion to morphine patient-controlled analgesia after abdominal surgery: a double-blinded, placebo-controlled randomized trial.
In this double-blinded, randomized controlled trial, we tested whether the addition of tramadol to morphine for patient-controlled analgesia (PCA) resulted in improved analgesia efficacy and smaller morphine requirements compared with morphine PCA alone after abdominal surgery in adults. Sixty-nine patients were randomly allocated into two groups, each receiving morphine 1 mg/mL via PCA after surgery. The tramadol group received an intraoperative initial loading dose of tramadol (1 mg/kg) and a postoperative infusion of tramadol at 0.2 mg. kg(-1). h(-1). The control group received an intraoperative equivalent volume of normal saline and a postoperative saline infusion. Postoperatively, tramadol was associated with improved subjective analgesic efficacy (P = 0.031) and there was significantly less PCA morphine use in the tramadol group (P = 0.023). No differences between the groups were found with regard to nausea, antiemetic use, sedation, or quality of recovery (all P > 0.05). We conclude that a tramadol infusion combined with PCA morphine improves analgesia and reduces morphine requirements after abdominal surgery compared with morphine PCA alone. ⋯ In this study, we determined whether adding a second pain-killing drug, tramadol, could improve pain relief after major surgery in patients receiving morphine patient-controlled analgesia. We found that patients receiving tramadol had significantly better opinions of their pain relief and used significantly less morphine with no increase in side effects.