European journal of anaesthesiology
-
Randomized Controlled Trial Clinical Trial
Epidural diamorphine infusions with and without 0.167% bupivacaine for post-operative analgesia.
Forty patients who underwent upper or mid-abdominal surgery were randomly allocated to receive a post-operative epidural infusion of 0.083 mg ml-1 of diamorphine in either 0.167% bupivacaine or 0.9% NaCl solution. The nursing staff, who were unaware of which solution was being infused, managed the patients' pain according to a standardized scheme. They adjusted the epidural infusion rates to 3, 5 or 7 ml h-1 according to the patient's hourly reports of pain on a four point verbal rating scale (none, mild, moderate or severe), aiming to use the lowest allowed infusion rate to prevent or reduce any pain that was more than mild. ⋯ Diclofenac was needed by six patients receiving diamorphine in saline and one receiving diamorphine in bupivacaine (P < 0.05). The range of average hourly epidural infusion rates was constrained by design to between 3 and 7 ml h-1 but the median of these values was 5 ml h-1 in the diamorphine-saline group and 3.35 ml h-1 in the diamorphine-bupivacaine group (P < 0.02). In patients receiving diamorphine in saline, a median of 6 (range 0-16) of the 24 h reports were of more than mild pain, whereas in the diamorphine-bupivacaine group, the corresponding figures were 2 (range 0-13) (P < 0.02)).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Randomized Controlled Trial Clinical Trial
Preferential channelling of anaesthetic solution injected within the perivascular axillary sheath.
Preferential channelling of anaesthetic solution injected into the perivascular axillary sheath was investigated in 40 patients undergoing elective orthopaedic upper-limb surgery. Three needles, with different approaches and inclinations, were inserted near the three main terminal branches of the brachial plexus using an axillary approach. ⋯ Back flow was observed, mainly in the needle nearest to the radial nerve during injection of the anaesthetic solution in the superior and inferior aspects of the brachial artery, and in the needle close to the ulnar nerve when the injection was performed posterior to the artery, near the radial nerve. These results could be related to the trapping of anaesthetic solution in unconnected compartments and to the slope of the needle injecting the anaesthetic solution which spreads preferentially along a gradient following the needle shaft direction.
-
Case Reports Comparative Study
Anaesthesia for electroconvulsive therapy: use of propofol revisited.
In three clinically depressed patients undergoing repeated electroconvulsive therapy (ECT) with either propofol or methohexitone, dose-dependent decreases in the duration of motor and EEG seizure activity were noted. Use of a 'minimally' hypnotic dose of propofol (0.75-1.0 mg kg-1) was associated with a seizure duration which was comparable to standard hypnotic doses of methohexitone. We conclude that doses of propofol < 1.5 mg kg-1 are associated with a clinically acceptable duration of EEG seizure activity (> 30 s) during ECT.
-
We describe the experience of the acute pain service of the University Hospital of Galicia, Spain since its inception. We have treated 1214 patients using either patient-controlled analgesia (PCA) with morphine (72%), or patient-controlled epidural analgesia with fentanyl + bupivacaine (22%). ⋯ Three (0.33%) patients using PCA had respiratory depression treated with naloxone; no patient with patient-controlled epidural analgesia had respiratory depression. In our experience the creation of an acute pain service and the associated development of pain-treatment protocols and the training of hospital personnel produced excellent results.
-
Case Reports Comparative Study
A patient's experience of a new post-operative patient-controlled analgesic technique.
A patient underwent major spinal surgery, twice within a 3 week period. On the first occasion his post-operative pain was managed by conventional morphine patient-controlled analgesia (PCA). ⋯ The results showed comparable quality of analgesia and sedation and similar effects on respiration. However, the patient expressed a preference for morphine PCA.