Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural infusions in the combined spinal/epidural technique for labor analgesia.
We compared the clinical effects of three epidural infusions initiated after subarachnoid medication was administered as part of the combined spinal/epidural technique for labor analgesia. Fifteen minutes after administering subarachnoid fentanyl 25 microg and 1 mL of bupivacaine 0.25%, and 5 min after an epidural test dose of 3 mL of bupivacaine 0.25%, women were randomized to receive an epidural infusion of saline, bupivacaine 0.125%, bupivacaine 0.0625%, or bupivacaine 0.04% with epinephrine 1:600,000. All epidural infusions were started at 10 mL/h, and all except the Saline Group also received fentanyl 2 microg/mL. The end point of the study was delivery or request for additional medication for analgesia. We found that time until request for additional analgesia was longest in women who received bupivacaine 0.125% (median duration, 300 min) versus saline (median duration, 118 min) (P = 0.0001) and was intermediate for bupivacaine 0.0625% and bupivacaine 0.04% (median duration, 162 and 180 min, respectively) (P = 0.0001 versus saline). Women who received bupivacaine 0.125% had the most motor block. We conclude that all the bupivacaine-based infusions we tested maintained the analgesia from subarachnoid medication longer than saline, with the longest duration, but the most motor block, from bupivacaine 0.125%. ⋯ In this prospective, randomized, and double-blinded study we found that initiating an epidural infusion of bupivacaine 0.125% with fentanyl 2 microg/mL at 10 mL/h 15 min after subarachnoid fentanyl 25 microg with 1 mL of bupivacaine 0.25%, followed by an epidural test dose of 3 mL of bupivacaine 0.25%, maintained the analgesia for longer but with more motor block than with either bupivacaine 0.04% or bupivacaine 0.0625%.
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Anesthesia and analgesia · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialA double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block.
To compare intraoperative and postoperative clinical properties of levobupivacaine and ropivacaine for sciatic nerve block, 50 ASA physical status I and II patients undergoing hallux valgus repair received a femoral nerve block with 15 mL of 2% mepivacaine. They were then randomly allocated in a double-blinded fashion to receive a sciatic nerve block with either 0.5% levobupivacaine (n = 25) or 0.5% ropivacaine (n = 25). An independent blinded observer evaluated the onset time of surgical anesthesia as well as the quality of the surgical block and postoperative analgesia. The median (range) onset time of surgical block at the sciatic nerve distribution was 30 min (5-60 min) with levobupivacaine and 15 min (5-60 min) with ropivacaine (P = 0.63). Four patients (two patients in each group) received a supplementary ankle block by the surgeon just before the beginning of surgery. All four patients also received IV fentanyl supplementation, but in three of them, propofol infusion was required to complete surgery (two in the Levobupivacaine group [8%] and one in the Ropivacaine group [4%]; P = 0.99). In six patients of the Levobupivacaine group (24%) and five patients of the Ropivacaine group (20%), IV fentanyl supplementation was required to complete surgery (P = 0.99). No differences in the time to recovery of sensory and motor function were observed between the two groups, whereas median (range) duration of postoperative analgesia was 16 h (8-24 h) with levobupivacaine and 16 h (8-24 h) with ropivacaine (P = 0.83). We conclude that 0.5% levobupivacaine and 0.5% ropivacaine provide comparable surgical anesthesia and postoperative analgesia. ⋯ No studies have compared the clinical properties of levobupivacaine with those of ropivacaine when providing sciatic nerve block for hallux valgus repair. Results from this prospective, randomized, double-blinded study demonstrate that 20 mL of either 0.5% levobupivacaine or 0.5% ropivacaine provide comparable surgical block with prolonged postoperative analgesia.
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Anesthesia and analgesia · Apr 2002
Randomized Controlled Trial Clinical TrialThe effect of methylene blue on the hemodynamic changes during ischemia reperfusion injury in orthotopic liver transplantation.
After graft reperfusion in orthotopic liver transplantation (OLT), ischemia reperfusion syndrome (IRS) is characterized by persistent hypotension with a low systemic vascular resistance. Methylene blue (MB) has been used as a vasopressor in sepsis and acute liver failure. We investigated the effect of MB on IRS during OLT. Thirty-six patients undergoing elective OLT were randomized to receive either a bolus of MB 1.5 mg/kg before graft reperfusion, or normal saline (placebo). We recorded hemodynamic variables, postoperative liver function tests, and time to hospital discharge. Blood samples were analyzed for arterial lactate concentration, cyclic 3',5'-monophosphate, and plasma nitrite/nitrate concentrations. The MB group had higher mean arterial pressure (P = 0.035), higher cardiac index (P = 0.04), and less epinephrine requirement (P = 0.02). There was no difference in systemic vascular resistance or central venous pressure. Serum lactate levels were lower at 1 h after reperfusion in MB patients, suggesting better tissue perfusion (P = 0.03). In the presence of MB, there was a reduction in cyclic 3',5'-monophosphate (P < 0.001), but not plasma nitrites. Postoperative liver function tests and time to hospital discharge were the same in both groups. MB attenuated the hemodynamic changes of IRS in OLT acting via guanylate cyclase inhibition. ⋯ Methylene blue attenuates the hemodynamic changes of the ischemia reperfusion syndrome in liver transplantation, and this effect involves guanylate cyclase inhibition.
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Anesthesia and analgesia · Apr 2002
Randomized Controlled Trial Clinical TrialKorean hand acupressure reduces postoperative nausea and vomiting after gynecological laparoscopic surgery.
To investigate the effectiveness of prophylactic Korean hand acupressure in the prevention of postoperative vomiting in women scheduled for minor gynecological laparoscopic surgery, we conducted a double-blinded, randomized, placebo-controlled study. In one group (n = 40), acupressure was performed 30 min before the induction of anesthesia by using special acupressure seeds, which were fixed onto the Korean hand acupuncture point K-K9 and remained there for at least 24 h. The second group (n = 40) functioned as the Placebo group. The treatment groups did not differ with regard to demographics, surgical procedure, or anesthetic administered. In the Acupressure group, the incidence of nausea and vomiting was significantly less (40% and 22.5%) than in the Placebo group (70% and 50%). We conclude that Korean hand acupressure of the acupuncture point K-K9 is an effective method for reducing postoperative nausea and vomiting in women after minor gynecological laparoscopic surgery. ⋯ This randomized study was performed to investigate the antiemetic effect of the Korean hand acupuncture point K-K9. Acupressure of K-K9 reduces the incidence of postoperative nausea and vomiting in female patients after minor gynecological laparoscopic surgery.
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Anesthesia and analgesia · Apr 2002
Comment Letter Randomized Controlled Trial Comparative Study Clinical TrialReduction of pain on injection of propofol: a comparison of fentanyl with remifentanil.