Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialTransnasal butorphanol: a new method for pain relief in post-cesarean section pain.
This study was undertaken to evaluate the efficacy and the safety of transnasal butorphanol (TNB) compared to intravenous butorphanol (IVB) in 186 patients experiencing moderate to severe post-cesarean section pain. Patients were randomly assigned to five groups in a double-blind fashion: Group I (n = 37) received 2 mg IVB, Group II (n = 38) 2 mg TNB, Group III (n = 36) 1 mg TNB followed by a repeat dose of 1 mg TNB at 60 min, Group IV (n = 38) 0.5 mg TNB followed by a repeat dose of 0.5 mg at 60 min, and Group V (n = 37) received placebo. All administrations were double dummy. ⋯ There were no incidences of nasal mucosa irritation, or cardiovascular or respiratory depression. It is concluded that transnasal butorphanol represents a safe and effective alternative to injectable butorphanol for post-cesarean section pain and offers a better and longer duration of analgesia compared to IV butorphanol. The optimum dose seems to be 2 mg TN butorphanol and it is tolerated better when divided into 1 mg increments, given 1 h apart.
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Acta Anaesthesiol Scand · Jan 1991
The effects of a 16-N-homopiperidino analogue of vecuronium on neuromuscular transmission in anaesthetized cats, pigs, dogs and monkeys, and in isolated preparations.
Org 9991, a 16-N-homopiperidinium substituted vecuronium analogue, has been tested for neuromuscular blocking activity in anaesthetized cats, pigs, dogs and monkeys, and in isolated nerve-muscle preparations. Org 9991 exhibited non-depolarizing neuromuscular blocking activity of the competitive type, being reversible by neostigmine and showing no endplate channel blocking action in isolated preparations. ⋯ The potency and time course of action of Org 9991 remained similar in all four species: i.e. 90% block at ca 200-300 micrograms kg-1; onset time ca 1.2-1.9 min; duration 90% ca 4.5-8.9 min. This study suggests that 16-N-homopiperidinium analogues of vecuronium may provide leads in the quest for a potent non-depolarizing replacement for suxamethonium.
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Acta Anaesthesiol Scand · Jan 1991
Long-term intrathecal morphine and bupivacaine in "refractory" cancer pain. I. Results from the first series of 52 patients.
Neither epidural (EDA) or intrathecal (IT) morphine nor EDA opiate + bupivacaine provides acceptable relief of some types of cancer pain, e.g. pain originating from mucocutaneous ulcers, deafferentation pain, continuous and intermittent visceral and ischaemic pain, and that occurring with body movement as a result of a fracture. To improve pain relief in such conditions, we gave combinations of morphine and bupivacaine through open IT-catheters to 52 patients with "refractory", severe (VAS 7-10 out of 10), complex cancer pain (Edmonton Stage-3), for periods of 1-305 (median = 23) days. The efficacy of the treatment was estimated from: 1) daily dosage (intraspinal and total opiates, and intraspinal bupivacaine), and 2) scores of non-opiate analgesic and sedative consumption, gait and daily activities, and amount and pattern of sleep. ⋯ The IT-treatment significantly decreased the total (all routes) opiate consumption and significantly improved sleep, gait and daily activities. For the whole period of observation (6 months), the IT-treatment was assessed as adequate in 3.8%, good in 23.1%, very good in 59.6% and excellent in 13.5% of the cases. Adverse effects of the IT-bupivacaine (paraesthesiae, paresis, gait impairment, urinary retention, anal sphincter disturbances and orthostatic hypotension) did not occur with doses of 2.5-3.0 mg/h (approx. 60-70 mg/day).
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Acta Anaesthesiol Scand · Nov 1990
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffect of epidurally administered bupivacaine on atracurium-induced neuromuscular blockade.
The effect of epidurally administered bupivacaine on duration, intensity and reversal characteristics of atracurium-induced neuromuscular blockade was studied in 30 healthy patients anaesthetized with thiopentone, fentanyl, midazolam and nitrous oxide. Fifteen patients received, in addition, epidural anaesthesia with bupivacaine. The remaining patients served as controls. ⋯ Post-tetanic count (PTC) after 20 min was also significantly lower in the epidural group (P less than 0.05). It is therefore concluded that epidurally administered bupivacaine prolongs atracurium-induced neuromuscular blockade. The clinical implication of the modest prolongation is, however, limited.
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Acta Anaesthesiol Scand · Nov 1990
Randomized Controlled Trial Clinical TrialClonidine premedication: a useful adjunct in producing deliberate hypotension.
The effect of clonidine on the dose requirements of labetalol and isoflurane for hypotension was studied in 20 adult patients undergoing middle-ear surgery. Group I (10 patients) received as premedication only pethidine 1 mg.kg-1 i.m., and Group II (10 patients) clonidine 4-5 micrograms.kg-1 p.o. in addition to pethidine. Fentanyl was used for analgesia and d-tubocurarine for muscle relaxation. ⋯ Urine flow rates (UF) were lower in Group II (0.23 +/- 0.04 ml.min-1) than in Group I (0.68 +/- 0.16 ml.min-1) before hypotension (P less than 0.05) and during hypotension (0.08 +/- 0.02 ml.min-1 vs. 0.68 +/- 0.32 ml.min-1, P less than 0.05). After anaesthesia, there was no difference in UF between the groups. The results indicate that clonidine can be used for deliberate hypotension to decrease the dose requirements of labetalol and isoflurane.