European journal of anaesthesiology
-
Randomized Controlled Trial Clinical Trial
Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomy.
This study was undertaken to determine whether epidural analgesia has any benefit for post-operative pain relief in patients undergoing laparoscopic cholecystectomy. Patients were randomly assigned to receive post-operative epidural analgesia with a morphine-bupivacaine combination (Group A, n = 22) or placebo (saline) (Group B, n = 22). The same standard general anaesthetic technique, which consists of nitrous oxide and isoflurane in oxygen was used. ⋯ At 24 h after anaesthesia, pain scores in Group A (2.3 +/- 1.2) were lower than those in Group B (4.4 +/- 1.5) (P < 0.05). However, at 48 h post-operatively, no difference in scores was observed between the two groups. In conclusion, epidural analgesia with a morphine-bupivacaine combination improves pain relief during the first 24 h following laparoscopic cholecystectomy.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Addition of droperidol to morphine administered by the patient-controlled analgesia method: what is the optimal dose?
Eighty patients were recruited into a double-blind, randomized trial to find the optimal dose of droperidol for addition to the patient-controlled analgesia (PCA) morphine infusate for female patients undergoing gynaecological surgery. A standardized anaesthetic technique was employed. Post-operative analgesia was provided by PCA morphine. ⋯ However, after 24 h, patients in group 4 were significantly more sedated than patients in groups 1 and 2 (P < 0.05). There were no significant differences between the groups in terms of the incidence of anxiety or other side effects attributable to droperidol. The present authors suggest that, although the results demonstrate few statistically significant differences between the four groups, a PCA bolus dose of droperidol of 0.10 mg mL-1 appears to provide the optimal balance between anti-emetic efficacy and an acceptable incidence of side effects.
-
Randomized Controlled Trial Clinical Trial
Effect of diluent volume on post-operative analgesia and sedation produced by epidurally administered midazolam.
We have studied the optimal diluent volume for post-operative analgesia and sedation produced by epidurally administered midazolam after upper abdominal surgery. Sixty patients were randomly allocated to four groups of 15 patients. When patients complained of pain after surgery, epidural midazolam 0.05 mg kg-1 in 3 mL saline (Group A), in 5 mL saline (Group B), in 10 mL saline (Group C) or in 15 mL saline (Group D) were injected as a bolus. ⋯ The interval to the second request for an analgesic was significantly shorter in Group D than in the other three groups. Memory retention of the pin-prick examination was reported by four patients in Group A. The present results indicate that 5-10 mL saline is the optimal volume for epidural injection when using midazolam 0.05 mg kg-1 for post-operative analgesia following upper abdominal surgery.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Pharmaco-economic evaluation of a disposable patient-controlled analgesia device and intramuscular analgesia in surgical patients.
The present study contrasted the pharmaco-economics and analgesic efficacy of intramuscular (i.m.) opioid treatment with a parenteral disposable patient-controlled analgesia (PCA) system in two groups of 20 female patients (ASA I-II, aged 35-69 years) scheduled for abdominal hysterectomy. The PCA group received a continuous infusion of 1.5 mg h-1 piritramide, a mu-opioid receptor agonist, with incremental doses of 1.5 mg (lock-out interval = 15 min). The i.m. group received 0.3 mg kg-1 piritramide i.m. when requested by the patient with a minimum interval of 5 h. ⋯ Both treatments initially provided comparable analgesia, but PCA was more efficient after 16 h and significantly reduced nursing time for pain treatment (PCA = 61 +/- 4 min, i.m. = 88 +/- 5 min; P < 0.001). Functional recovery was not different for either treatment. Cost analysis indicated a better cost-benefit ratio for the i.m. treatment (0.35 vs. 1.1 for PCA treatment), but a similar cost-effectiveness for both treatments (PCA = 1.9 Belgian Francs (BEF) unit-1 SPID; i.m. = 1.7 BEF unit-1 SPID).
-
Randomized Controlled Trial Clinical Trial
Effective dose of granisetron for the prevention of post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.
This study was undertaken to determine the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for the prevention of post-operative nausea and vomiting (PONV) in female patients undergoing elective laparoscopic cholecystectomy. In randomized, placebo-controlled, double-blind study, 120 women were assigned to receive either placebo (saline) or granisetron at three different doses (20 micrograms kg-1, 40 micrograms kg-1 or 80 micrograms kg-1) intravenously immediately before the induction of anaesthesia. ⋯ Adverse effects post-operatively were not different among the groups. In conclusion, granisetron 40 micrograms kg-1 is the minimum effective dose in the prevention of PONV after laparoscopic cholecystectomy.