Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialEffect of pre-incision skin infiltration on post-hysterectomy pain--a double-blind randomized controlled trial.
In this double-blind placebo-controlled randomized trial, we compared the analgesic effect of preoperative 0.25% bupivacaine (n = 21) skin infiltration with normal saline (n = 19) in patients undergoing abdominal hysterectomy through a lower midline incision. All patients received postoperative patient-controlled analgesia with morphine and were followed for 72 hours. The main outcome measures were morphine consumption and pain score at rest, and the contribution of different components of pain was also assessed prospectively. ⋯ Visceral pain predominated in the first 48 hours. We concluded that local anaesthetic infiltration is not effective in reducing pain after abdominal hysterectomy. Effective postoperative analgesia should aim to eliminate the visceral pain component.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialTenoxicam i.v. in major gynaecological surgery--pharmacokinetic, pain relief and haematological effects.
This study compared postoperative analgesic dispensation and measures relating to haemostasis following intravenous administration, in a randomized double-blinded manner, of either placebo or tenoxicam 20 mg to 30 women presenting for major gynaecological oncology surgery under a standardized, combined epidural/general anaesthetic technique. Pharmacokinetic disposition of tenoxicam in this patient cohort was also described. There was no objective or subjective alteration in haemostatic function or increase in blood loss, nor any deviation from the normal range of values. ⋯ There were no significant side-effects and no adverse events attributable to tenoxicam. In this small study we have shown that tenoxicam administered preoperatively reduced the epidural analgesic requirements during the first 48 hours following major gynaecological surgery. There was no clinical or pathological evidence of haematological impairment following a single i.v. administration of tenoxicam 20 mg.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialTiming of midazolam and propofol administration for co-induction of anaesthesia.
We aimed to determine the optimum timing of midazolam administration prior to propofol to achieve the maximal reduction in the dose of propofol required to induce anaesthesia. Female (ASA 1-2) patients, aged 18 to 45 years, weighing 40 to 75 kg and scheduled for gynaecological surgery were eligible for the study. Consenting patients were randomly assigned to six groups. ⋯ There was no significant (P = 0.14) difference in propofol ED50 among the five groups which received midazolam. Patients who received midazolam had less recollection of events surrounding induction (P < 0.001) and recalled the induction experience as being more pleasant (P = 0.03) than those who did not receive midazolam. These results indicate that midazolam may be given up to 10 minutes prior to propofol and still achieve a substantial dose reduction.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialThe effect of adding fentanyl to ropivacaine 0.125% on patient-controlled epidural analgesia during labour.
The use of patient-controlled epidural analgesia (PCEA) for labour analgesia is rapidly gaining acceptance. However, the ideal PCEA solution and PCEA program remains uncertain. We studied the effect of adding fentanyl 2 micrograms/ml on demand-only PCEA using ropivacaine 0.125% for labour analgesia. ⋯ The ratio of successful PCEA demand to total number of demands, the satisfaction score and the maternal-fetal outcome were similar in both groups. In conclusion, the addition of fentanyl had a dose-sparing effect on the requirement of ropivacaine. This PCEA regimen produced a low incidence of motor block, good labour pain relief and excellent patient satisfaction.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialDoes adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery?
The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. ⋯ The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.