The Journal of international medical research
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Randomized Controlled Trial Clinical Trial
The effect of caudal bupivacaine versus tramadol in post-operative analgesia for paediatric patients.
In this study 20 paediatric surgical patients were randomized to two groups after induction of general anaesthesia. Group 1 received 0.25% bupivacaine (2 mg/kg) and group 2 received 5% tramadol (2 mg/kg) both as a caudal block. Heart rate, mean arterial pressure, arterial oxygen saturation, respiratory rate and pain and sedation scores were recorded at 1, 2, 4, 6, 12 and 24 h post-operatively. ⋯ The pain and sedation scores in group 2 were significantly lower compared with group 1. There were no significant differences in heart rate, mean arterial pressure, arterial oxygen saturation and respiratory rate between the two groups. In conclusion, caudal tramadol was superior to bupivacaine in analgesic efficacy and in reducing the need for additional analgesia during the post-operative period in paediatric patients.
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Interscalene brachial plexus block (ISB) anaesthesia is widely used with or without general anaesthesia in patients undergoing shoulder surgery, which is generally done with the patient in a sitting position. This position affects haemodynamics, and supplementing ISB with general anaesthesia can exaggerate these haemodynamic changes. This study compared ISB combined with general anaesthesia, with ISB alone, in 29 patients undergoing elective shoulder surgery. ⋯ All of the patients were either satisfied or entirely satisfied with their anaesthesia/analgesia. There were no significant differences in side-effects and no severe complications in either group. We advocate using ISB alone for patients undergoing shoulder surgery, but further larger studies are needed to confirm the present results.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the antiemetic efficacy of tropisetron and droperidol with patient-given tramadol.
We compared the antiemetic efficacy of tropisetron versus droperidol in women given tramadol after total hysterectomy. Forty patients were randomly allocated to group 1 (n = 20, tropisetron 0.05 mg/kg intravenously) or group 2 (n = 20, droperidol 15 micrograms/kg intravenously). Tramadol infusion (intravenously), for post-operative analgesia, was started at fascia closure. ⋯ Vomiting and nausea incidences were reported fewer in group 1 than in group 2, but statistical significance was only reached for vomiting incidence 6 h post-operation. Tropisetron seems to have better antiemetic properties than droperidol in patients receiving tramadol because of the length of its duration of action. Further studies, investigating alternative ways of managing post-operative nausea and vomiting, and the use of tramadol for post-operative analgesia, are needed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Celecoxib is as efficacious as naproxen in the management of acute shoulder pain.
This study compared the analgesic efficacy and safety of the cyclo-oxygenase-2 specific inhibitor celecoxib with the non-specific non-steroidal anti-inflammatory drug, naproxen, in patients with acute shoulder pain. Adult patients with shoulder pain, onset within the previous 14 days and shoulder pain of > or = 40 mm on a 100 mm visual analogue scale (VAS), were treated with oral doses of celecoxib or naproxen for 14 days and followed by a visit at day 42 in a double-blind, randomized study. The primary efficacy assessment was change in maximum pain at rest on a 100 mm VAS at day 14 compared with baseline. ⋯ Fewer patients experienced epigastric pain with celecoxib (seven patients versus 14 with naproxen). This adverse event led to discontinuation in two patients receiving celecoxib and five receiving naproxen. Celecoxib 400 mg/day was at least as effective as naproxen 1 g/day in managing pain in this condition.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sedation for outpatient endometrial biopsy: comparison of remifentanil-propofol and alfentanil-propofol.
The purpose of the study was to compare the clinical activity of remifentanil or alfentanil under propofol sedation with regard to respiratory rate, sedation and recovery rate when used for outpatient endometrial biopsy. Patients were randomized to receive intravenously either bolus remifentanil 0.4 microgram/kg and propofol 1 mg/kg in the remifentanil group (n = 30), or bolus alfentanil 20 micrograms/kg and propofol 1 mg/kg in the alfentanil group (n = 30). Patients were monitored for heart rate, systolic and diastolic arterial pressure, peripheral O2 saturation (SpO2), respiration rate, and Aldrete sedation score. ⋯ The groups did not differ with regard to apnoea incidences. Times were recorded for orientation and Aldrete score > 8, and were similar between the two groups (13.20 +/- 3.64 min and 14.0 +/- 3.87 min in the remifentanil group, 14.7 +/- 3.64 min and 15.9 +/- 3.15 min in the alfentanil group, respectively). The sedative and analgesic combination of remifentanil-propofol does not offer any advantages compared with a combination of alfentanil-propofol with regards to respiration and recovery during sedation for outpatient endometrial biopsy.