Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
The morphine sparing effect of ketorolac tromethamine. A study of a new, parenteral non-steroidal anti-inflammatory agent after abdominal surgery.
A randomised, double-blind study of patients after upper abdominal surgery was undertaken to assess the analgesic efficacy of ketorolac tromethamine, a new, parenteral non-steroidal anti-inflammatory agent. Postoperatively, patients received a 24-hour intramuscular infusion of either saline (n = 20), ketorolac 1.5 mg/hour (n = 21) or ketorolac 3.0 mg/hour (n = 20). Cumulative morphine requirements were measured using a patient-controlled analgesia system which delivered intravenous increments of morphine on demand. ⋯ This was associated with significantly lower pain scores. Patients who received the higher ketorolac dose had significantly less postoperative increase in arterial carbon dioxide tensions than controls. This study suggests that ketorolac tromethamine is a useful analgesic drug with significant morphine sparing properties.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nalbuphine for obstetric analgesia. A comparison of nalbuphine with pethidine for pain relief in labour when administered by patient-controlled analgesia (PCA).
A double-blind, randomised study of 60 patients who received intravenous increments of nalbuphine 3 mg or pethidine 15 mg by patient-controlled analgesia during the first stage of labour, was carried out. Pain intensity, sedation, uterine contractions, maternal cardioventilatory variables and fetal heart rate were recorded as well as any side effects. ⋯ Group mean values of pain scores of nalbuphine-medicated primiparous women were statistically significantly lower than those of pethidine-medicated patients (p less than 0.01). Other assessments did not demonstrate a statistical significance between the two groups.
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Case Reports
Brachial plexus block. Unilateral thoraco-abdominal blockade following the supraclavicular approach.
A supraclavicular brachial plexus block was performed which resulted in unilateral sensory and motor blockade of the thoracic and abdominal walls. General anaesthesia was therefore used and postoperatively it was noticed that analgesia of the upper limb had developed. It is likely that the blockade resulted from an intrapleural injection of local anaesthetic.
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The anaesthetic management of a 26-year-old woman who sustained an unstable fracture of C2 when 40 weeks pregnant, is described.
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Tracheal intubation may be hindered by difficulty in insertion of the laryngoscope blade into the patient's mouth because the handle impinges on the patient's chest or on the hand of an assistant applying cricoid pressure. An adaptor is described which modifies the standard Penlon laryngoscope to enable lateral swivelling of the handle, thus avoiding the obstruction.