Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialContinuous positive airway pressure by mask in patients after coronary surgery.
Thirty patients who underwent coronary artery bypass grafting were randomized to receive 30% oxygen by mask either with an ambient airway pressure or with 7.4 mmHg (1 kPa) continuous positive airway pressure (CPAP) for 8 h after extubation. Arterial blood oxygen tension (PaO2) decreased remarkably in the control group after extubation (from 19.2 +/- 5.3 kPa to 12.4 +/- 2.7 kPa) but less in the CPAP group (from 16.4 +/- 3.3 kPa to 14.0 +/- 2.1 kPa). ⋯ Atelectasis was more common in patients with internal thoracic artery grafting and/or pleural drainage. In conclusion, CPAP therapy was well tolerated, and minimized the decrease in PaO2 after extubation, but could not prevent the poor oxygenation or the late development of atelectatic areas on the second postoperative day.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialThe effect of balanced analgesia on early convalescence after major orthopaedic surgery.
Forty-two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid and acetaminophen regimen. Patients undergoing knee- or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilization under the 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observed after cessation of the epidural regimen. ⋯ Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care, were the most important reasons limiting mobilization and activity. We conclude that effective early (48 h) postoperative pain relief with balanced analgesia does not per se lead to important improvements in convalescence and hospital stay.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialInterpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study.
The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg.ml-1 with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. ⋯ Adequacy of pain relief was evaluated with the Prins-Henry pain scale. Morphine requirement was registered, there was no difference between the groups in pain scores or need for additional morphine.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialIntraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia.
Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight-in-patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. ⋯ Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of continuous epidural infusion of morphine/bupivacaine with fentanyl/bupivacaine for postoperative pain relief.
The efficacy and safety of postoperative analgesia with continuous epidural infusion of either morphine or fentanyl in combination with bupivacaine were evaluated in 85 patients, ASA physical status I or II, undergoing thoracic and/or upper abdominal surgery. Patients were treated with one of the combinations for 48 h after surgery. The morphine/bupivacaine group (MB; n = 45) received morphine at the rate of 0.2 mg.h-1, and bupivacaine at the rate of 10 mg.h-1 for the first 24 h or 5 mg.h-1 for the second 24 h; the fentanyl/bupivacaine group (FB; n = 40) received fentanyl at the rate of 20 micrograms.h-1, and bupivacaine at the rate of 10 mg.h-1 for the first 24 h or 5 mg.h-1 for the second 24 h. ⋯ No significant differences were observed between the groups in assessment of pain. The incidence of hypotension (P < 0.05) and pruritus (P < 0.05) was higher in group MB than in group FB. None of the patients developed respiratory depression in either group.