The Journal of international medical research
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Randomized Controlled Trial Comparative Study
Comparison of epidural and combined spinal-epidural analgesia in the management of labour without pain.
The effects of combined spinal-epidural analgesia (CSEA) and epidural analgesia (EA) were studied in 50 healthy parturients randomly allocated to receive bupivacaine plus fentanyl either epidurally, or intrathecally and epidurally. Significant differences from baseline values were seen in systolic blood pressure at all time-points except for 4 h in the EA group and at 3 and 4 h in the CSEA group. ⋯ The duration of labour and total amount of drugs used were significantly decreased and cervical dilatation was faster with CSEA compared with EA. In conclusion, CSEA was associated with more rapid onset of analgesia and faster progress in cervical dilatation compared with EA, and can be used safely for labour analgesia.
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Randomized Controlled Trial Comparative Study
A comparison of the efficacies of different pre-treatment drugs in resolving the injection pain of rocuronium.
Efficacies of pre-treatment with lidocaine, remifentanil and metoclopramide in the reduction of pain and withdrawal movements induced by rocuronium injection were evaluated. Forty-four adult patients, American Society of Anesthesiologists (ASA) Physical Status I-II, undergoing elective surgery were randomly assigned to four groups. Each patient received intravenously either 10 mg metoclopramide, 50 mg lidocaine, 1 microg/kg remifentanil or 3 ml of 0.9% sodium chloride (control group); followed by occlusion with a tourniquet on the forearm. ⋯ After loss of consciousness with sodium thiopental, 0.6 mg/kg rocuronium was administered for intubation and withdrawal movements were assessed. The number of patients in whom withdrawal movements were lowest was in the lidocaine-treated group. Although there was no difference among the study drugs in the prevention of rocuronium-induced pain, lidocaine and remifentanil seemed to be clinically more effective than metoclopramide.
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Effective pain relief following adenotonsillectomy in children remains a challenge. This study evaluated the effects of intramuscular 0.5 mg/kg ketamine, 1 mg/kg tramadol or 1 mg/kg meperidine on post-operative pain and recovery in 45 children aged 1-7 years undergoing adenotonsillectomy. Anaesthesia was induced with thiopental or sevoflurane (with succinylcholine for intubation) and was maintained with sevoflurane in oxygen and nitrous oxide. ⋯ At all other time-points after extubation, mean post-operative pain scores were similar for the three treatment groups. Ketamine was associated with a significantly higher mean agitation score compared with tramadol and meperidine. We conclude that the effects of ketamine, meperidine and tramadol on post-operative pain following adenotonsillectomy in children were similar.
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Comparative Study
Magnesium sulphate attenuates tourniquet-induced hypertension and spinal c-fos mRNA expression: a comparison with ketamine.
Magnesium and ketamine are well-known N-methyl-D-aspartic acid receptor antagonists. The aim of this study was to determine whether magnesium, in comparison with ketamine, attenuates tourniquet-induced hypertension and spinal c-fos mRNA expression. Rats were divided into four treatment groups: normal (baseline for c-fos mRNA expression); control (saline injection); magnesium injection; and ketamine injection. ⋯ Human patients under sevoflurane-oxygen/nitrous oxide anaesthesia were also assigned to receive similar treatments. In humans, arterial blood pressure was increased in the control group at 50 min and thereafter compared with the magnesium and ketamine groups; the magnesium and ketamine groups did not differ. Magnesium and ketamine are equally effective in attenuating tourniquet-induced hypertension and spinal c-fos mRNA expression, suggesting that this effect may be due to reduced pain transmission.