European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of injection speed on anaesthetic spread during axillary block using the orthogonal two-needle technique.
One hundred patients undergoing scheduled upper limb orthopaedic surgery were studied to determine if the speed of injection of the local anaesthetic solution could modify the extent and depth of anaesthesia with the axillary approach to the brachial plexus. The blocks were performed using the 'orthogonal two-needle technique' in which two needles are positioned on the upper and on the lower aspect of the axillary artery, orthogonal to the neurovascular bundle and directed towards the fascial compartment containing the radial nerve. The patients were randomly assigned to one of three groups to receive one of three injection rates (10, 20 and 30 s) (n = 30). ⋯ A significant association was found between the injection rate and the anaesthetic spread for all tested areas with the exception of the regions supplied by the median nerve. A greater speed of injection was associated with less anaesthetic spread and more frequent block failure. A clear association between the anaesthetic spread to all branches of the brachial plexus and a slower injection rate of the local anaesthetic was found.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of bupivacaine plus buprenorphine with bupivacaine alone by caudal blockade for post-operative pain relief after hip and knee arthroplasty.
In a double-blind, parallel group trial, 15 patients who were given a caudal injection of 1.8 mg kg-1 of bupivacaine after induction of anaesthesia, were compared with 15 patients in whom 7.2 mg kg-1 of buprenorphine was added to the same dose of bupivacaine, prior to knee or hip replacement surgery. The duration of analgesia was much longer (mean 606 min vs. 126 min P < 0.001) in those receiving added buprenorphine; mean morphine consumption in the first 24 h was halved (14 mg vs. 28 mg) and patient satisfaction greatly increased. There were no significant differences in the incidence of complications although the group which had added buprenorphine had a lower incidence of vomiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of ketorolac and diclofenac on post-laparoscopic cholecystectomy pain.
In a randomized, double-blind, placebo-controlled study designed to assess the post-operative analgesic efficacy and cost-effectiveness of ketorolac and diclofenac 60 ASA I and II patients undergoing laparoscopic cholecystectomy were studied. Prior to concluding the operative procedure, an injection (i.m.) of an equal volume of either saline 3 mL, ketorolac 60 mg, or diclofenac 75 mg was administered. All patients received intravenous morphine via a patient-controlled analgesia device (PCA). ⋯ Diclofenac has the added advantage, in our institution, of being 60% less expensive than ketorolac. We conclude that both ketorolac and diclofenac are effective post-operative analgesic drugs. However, economic considerations may favour diclofenac administration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of maintenance and recovery characteristics of sevoflurane-nitrous oxide and enflurane-nitrous oxide anaesthesia.
We compared maintenance of anaesthesia and recovery using either sevoflurane or enflurane anaesthesia in ASA I-III patients undergoing surgery with an anticipated minimum duration of 3 h. Serum fluoride concentrations were also measured to assess the potential for renal toxicity. After induction of anaesthesia with thiopentone, patients received, for maintenance, either 1.5% end-tidal sevoflurane (0.73 MAC) with N2O 58% (0.58 MAC) (n = 40) or 1.2% end-tidal enflurane (0.7 MAC) with N2O 57% (0.57 MAC) (n = 40). ⋯ The mean peak plasma inorganic fluoride ion concentrations were reached 4 h after operation in both groups (27.7 microM L-1 for sevoflurane and 16.75 microM L-1 for enflurane, P < 0.05) declining 50% within 24 h in both groups. A positive correlation (P < 0.05) was found between anaesthetic exposure (MAC h) and fluoride concentrations in the two groups. Sevoflurane anaesthesia resulted in similar haemodynamic stability, recovery times and post-operative side effects as enflurane anaesthesia, but produced significantly greater serum fluoride levels.
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Randomized Controlled Trial Clinical Trial
The use of lignocaine to reduce pain on i.v. injection of diluted nalbuphine.
A randomized, placebo-controlled, double-blind study was conducted on 66 healthy patients aged 10-61 years undergoing elective ear, nose and throat surgery to assess the incidence and severity of pain associated with intravenous (i.v.) injection of diluted nalbuphine HCl given during induction of general anaesthesia, and to determine the efficacy of adding lignocaine (2 mg mL-1) to nalbuphine to reduce this pain. Injection of saline produced pain of low intensity in 15% of patients and a withdrawal response in 3% of patients. ⋯ The diluted nalbuphine alone produced the highest incidence (61%) of pain (P < 0.01 vs. saline, P = NS vs. nalbuphine with lignocaine), which was most severe (P < 0.01 vs. saline, P < 0.025 vs. nalbuphine with lignocaine), and caused the highest number (27%) of withdrawal responses (P < 0.01 vs. saline, P < 0.025 vs. nalbuphine with lignocaine). We conclude that diluted nalbuphine 2 mg mL-1 produces pain on i.v. injection into peripheral veins, and that this can be significantly reduced by adding lignocaine 2 mg mL-1 to the solution.