Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural tramadol for postoperative pain relief.
The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. ⋯ The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).
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Randomized Controlled Trial Comparative Study Clinical Trial
The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: a study with vecuronium and atracurium.
The effects of tracheobronchial suction before and after neuromuscular blockade with vecuronium (0.12 mg.kg-1; ED95 x 2; group A) and atracurium (0.4 mg.kg-1; ED95 x 2; group B) on intracranial pressure were studied in 18 neurosurgical patients with a Glasgow Coma Scale < 7. Despite adequate sedation, moderate to severe diaphragmatic movements (bucking and coughing) in response to carinal stimulation with significant increases in intracranial pressure (A: 18 SD 7 to 24 SD 8 mmHg; B: 19 SD 7 to 27 SD 5 mmHg) and subsequent decreases in cerebral perfusion pressure (group A: 69 SD 11 to 63 SD 8 mmHg; group B: 63 SD 11 to 59 SD 17 mmHg) could be observed without muscle relaxation. ⋯ Slight diaphragmatic movements could be elicited in only two patients in group A and in two patients in group B during tracheal suction; intracranial pressure (group A: 20 SD 8 to 20 SD 8 mmHg; group B: 19 SD 7 to 19 SD 7 mmHg) and cerebral perfusion pressure (group A: 65 SD 13 to 65 SD 13 mmHg; group B: 66 SD 12 to 65 SD 11 mmHg) remained unchanged. When coordinating respiratory therapy in neurosurgical intensive care patients, profound neuromuscular block, quantified by a post-tetanic count of at least 5 for vecuronium and 1 for atracurium, it is necessary to rule out any impact of diaphragmatic movement on intracranial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Dose-response for analgesic effect of amitriptyline in chronic pain.
A randomised, double-blind, multiple dose, crossover study with three 3-week treatment periods was set up to compare the analgesic efficacy and adverse effects of amitriptyline in oral doses of 25, 50 or 75 mg. Patients used diaries to assess their pain, and clinic assessments were made at the end of each treatment period. ⋯ The incidence of adverse effects was significantly higher with the 75 mg dose, and the principal adverse effects were dry mouth and drowsiness. In the context of chronic pain, the analgesic effect of amitriptyline was shown to have a dose-response unrelated to mood elevation, but there was a dose-response for the incidence of adverse effects.