European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast reconstruction.
Tramadol is a weak centrally acting analgesic and it might provide efficacious postoperative pain relief with minimal sedative effects in the use of intravenous patient-controlled analgesia (PCA). Sixty women scheduled to undergo microvascular breast reconstruction under standard general anaesthesia were enrolled in a study on the performance of patient-controlled analgesia with tramadol or morphine with special emphasis on drug- and technique-related side-effects. Seven patients were re-operated within the same day, leaving 25 patients in the tramadol group and 28 in the morphine group for comparison. ⋯ The remaining patients performed similarly in the Digit Symbol Substitution Test. In women receiving intravenous PCA for analgesia after microvascular breast reconstruction tramadol and morphine provided comparable postoperative analgesia with similar sedative effects. However, tramadol was associated with a disturbingly high incidence of nausea and vomiting.
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A recent study in our department demonstrated that depressing the plunger of a 50-mL syringe was reliably and linearly related to the force applied between 20 N and 50 N. Using a 50-mL syringe we constructed a simple device to help train anaesthetic assistants to apply cricoid pressure correctly. We then tested anaesthetists, operating department practitioners (non-physicians) and nurses in our hospital to see if they could correctly apply forces of 20 and 40 N. ⋯ Training leads to a significant improvement in performance (P < 0.005 at 20 N and P < 0.001 at 40 N) which is maintained for 1 week for both 20 N (P < 0.05) and 40 N (P < 0.05) but not for 1 month. Therefore training should be practised on a weekly basis. This is an inexpensive and simple device that we believe to be useful in helping anaesthetic assistants to apply effective cricoid pressure.
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We studied a number of factors that may be associated with urinary retention, in particular the method of postoperative analgesia delivery, in 47 men and 69 women undergoing lower limb joint replacements. The following factors were studied: age, gender, height, weight, previous history of urinary retention, presence of symptoms suggestive of urinary tract obstruction, type of anaesthetic (general anaesthetic or spinal anaesthetic), type of postoperative analgesia (intramuscular or patient-controlled analgesia with morphine) and the total dose of morphine given. ⋯ Stepwise logistic regression analysis was used to identify independent explanators of an increased probability of developing urinary retention. Three factors emerged - male gender, increasing age and the use of patient-controlled analgesia.