Anaesthesia and intensive care
-
Anaesth Intensive Care · Aug 1995
Randomized Controlled Trial Clinical TrialThe efficacy of adding a continuous intravenous morphine infusion to patient-controlled analgesia (PCA) in abdominal surgery.
The effect of adding a continuous infusion of morphine 1 mg/hr to patient-controlled intravenous analgesia was studied in a randomized double-blind trial. Ninety-six patients scheduled for abdominal surgery were enrolled; 38 received PCA and continuous infusion (PCA + C), 45 received PCA alone and 13 were excluded because of protocol violations. PCA was delivered via an ABBOTT 4200 pump with settings of morphine 1 mg bolus and five-minute lockout in both groups. ⋯ The PCA group delivered more PCA morphine during 0500-0800 hours and 0800-2200 hours on the first day only. There was no significant difference in the D/D ratio for any time period during the three days. Total morphine delivery was greater in the PCA + C group on the second and third postoperative days (P = 0.009 and P = 0.0001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anaesth Intensive Care · Aug 1995
Randomized Controlled Trial Clinical TrialClinical experience with patient-controlled and staff-administered intermittent bolus epidural analgesia in labour.
A prospective, randomized study was performed to detail clinical experience with both patient-controlled epidural analgesia (PCEA) and midwife-administered intermittent bolus (IB) epidural analgesia during labour, under the conditions pertaining in a busy obstetric delivery unit. Both methods used 0.125% bupivacaine plus fentanyl, and similar rescue supplementation, although management decisions related to epidural analgesia were made principally by attending midwives. One hundred and ninety-eight women were recruited and data analysed from 167 (PCEA n = 82, IB n = 85). ⋯ The PCEA group had a significantly higher rate of supplementation and bupivacaine use (P < 0.01), and a longer duration of the second stage of labour (P < 0.03). The relative risk of instrumental delivery with PCEA versus the IB method was 1.57 (CI 1.07-2.38). Experience within our unit with PCEA is contrasted with that of IB epidural analgesia, the method most commonly used; and with that of controlled trials comparing these two methods.
-
Anaesth Intensive Care · Aug 1995
Comparative StudyPain and vomiting after vitreoretinal surgery: a potential role for local anaesthesia.
Periconal local anaesthesia with subtenon supplementation was used to provide anaesthesia for 94 patients having vitreoretinal surgery. Of these, 44 patients also received general anaesthesia with neuromuscular block. None of these patients received opioid or antiemetic before or during surgery. ⋯ For patients having general anaesthesia, administration of an intraoperative antiemetic reduced the incidence of vomiting within six hours of the completion of surgery (P = 0.008). For patients who did not receive local anaesthetic, shorter operating time was a factor associated with both reduced postoperative vomiting (P = 0.0015) and administration of parenteral opioid (P = 0.0014). It is suggested that the use of local anaesthesia as part of the anaesthetic technique for vitreoretinal surgery is associated with improved patient comfort.
-
Anaesth Intensive Care · Aug 1995
Sacral intervertebral approach for epidural anaesthesia in infants and children: application of "drip and tube" method.
Sacral intervertebral approach to the epidural space was introduced as an alternative to the caudal approach in infants and children in 1987. We performed single-shot epidural anaesthesia in 200 infants and children with this approach using the "drip and tube" method for identification of the epidural space. ⋯ Overall success rate of the block was 96%. This approach to the epidural space is anatomically easy in infants and children, and application of our "drip and tube" method might make the paediatric single-shot epidural anaesthesia safer and more successful.