Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1983
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for haemorrhoid surgery.
Seventy patients undergoing haemorrhoidectomy under general anaesthesia were randomly allocated to one of five treatment groups in order to compare the effectiveness of various caudal agents in the control of postoperative pain. Four groups were given a caudal injection of either 2% lignocaine, 0.5% bupivacaine, 2% lignocaine + morphine sulphate 4 mg or normal saline + morphine sulphate 4 mg, while the fifth (control) group did not receive an injection. The number of patients requiring postoperative opiates was significantly higher in the lignocaine group than in the morphine (p less than 0.05) and morphine-lignocaine (p less than 0.05) groups. ⋯ In those who received opiates, the mean analgesic period was 228 minutes in the control group, and was significantly longer following bupivacaine (577 min, p less than 0.01), morphine-lignocaine (637 min, p less than 0.05) and morphine (665 min, p less than 0.0). The mean analgesic period following lignocaine (349 min) was not significantly different from control. The incidence of catheterisation was lowest in those patients who did not receive caudal analgesia.
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Anaesth Intensive Care · Feb 1983
Femoral nerve block--the anatomical basis for a single injection technique.
A technique for blocking the femoral nerve using a single needle placement is described. It depends on an appreciation of the anatomy and the need to feel loss of resistance twice as two fascial layers are penetrated during insertion of the needle just lateral to the femoral artery. A single injection of bupivacaine 0.35-0.5 per cent of at least 0.3 ml/kg will produce a satisfactory block.
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Anaesth Intensive Care · Feb 1983
Case ReportsThe management of headache following accidental dural puncture in obstetric patients.
The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. ⋯ The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.
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A modification of the traditional method of lumbar sympathetic blockade is described. A semi-prone patient position, combined with vertical X-ray screening, are employed to facilitate determination of the level and angle of needle insertion.