Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural sufentanil versus intramuscular buprenorphine for postoperative analgesia. A double-blind comparative trial.
Epidural sufentanil 50 micrograms was compared with intramuscular buprenorphine 0.3 mg for postoperative pain relief. Patients were assigned randomly to one of two treatment groups and received both an intramuscular and epidural injection, one of which was a placebo. ⋯ Cardiovascular variables remained stable in all patients and no respiratory depression was observed. Side effects were more frequent following buprenorphine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Subarachnoid block with hyperbaric lignocaine. A comparison with hyperbaric bupivacaine.
A double-blind study was carried out in 20 patients to compare 5% hyperbaric lignocaine and 0.5% hyperbaric bupivacaine for subarachnoid block. The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects and the frequency of side effects were studied. ⋯ Bupivacaine produced a longer duration of action in the lumbar and sacral segments but the duration in the thoracic segments was similar. There was a considerable degree of hypotension in both groups but this responded readily to ephedrine. Hyperbaric lignocaine is an alternative to hyperbaric bupivacaine and its shorter duration of action in the lumbar and sacral segments is advantageous when a fast recovery is desirable.
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Comparative Study
Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective caesarean section.
Duration of analgesia and side effects following single bolus doses of epidural fentanyl (100 micrograms) or sufentanil (10, 20, 30 or 50 micrograms) were studied in 50 patients who underwent Caesarean section under epidural anaesthesia. Fewer patients experienced pain peroperatively in the fentanyl group than in a joint group of those given sufentanil 20 or 30 micrograms (p less than 0.05). The combined fentanyl and sufentanil 50 micrograms groups had fewer patients in pain than the sufentanil 10 micrograms group at 3 hours after injection (p less than 0.05). ⋯ The sufentanil 50 micrograms group had more patients asleep than the 10 micrograms group and also had more patients with pruritus than the 10 micrograms or 30 micrograms groups (p less than 0.02). The patients given sufentanil 30 and 50 micrograms had more emetic sequelae than those who received sufentanil 10 and 20 micrograms or fentanyl 100 micrograms (p less than 0.05). There was no detectable excretion of drug into breast milk and no significant respiratory depression at the time of first postoperative analgesia in the patients who received fentanyl or 30 micrograms or less of sufentanil.
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Case Reports
Spinal cord compression during chronic epidural morphine administration in a cancer patient.
A case is described of thoracic spinal cord compression that occurred during continuous epidural administration of morphine. Sensory loss and motor weakness in the legs disappeared after catheter removal and antibiotic treatment.
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An infant with Goldenhar's syndrome is presented in whom two-stage plastic surgery was undertaken. The first operation, at the age of 5 months, necessitated a retrograde technique for tracheal intubation while in the second, at 10 months of age, conventional intubation was possible. The discussion highlights those refinements that promote a successful outcome when retrograde intubation is indicated, particularly in infants.