Anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Single oral dose ondansetron in the prevention of postoperative nausea and emesis. The European and US Study Groups.
In two placebo-controlled, double-blind, multicentre studies, the efficacy and safety of single oral doses of ondansetron 4 mg, 8 mg and 16 mg were evaluated for the prevention of postoperative nausea and vomiting in female inpatients. For the total study populations, 26% (European study) and 32% (US study) of placebo-treated patients experienced no emesis compared with 54% (European study) and 52% (US study) of patients treated with ondansetron 16 mg, the most effective dose. Similarly, 22% (European study) and 19% (US study) of placebo-treated patients experienced no nausea compared with 42% (European study) and 34% (US study) of ondansetron 16 mg-treated patients. ⋯ In the US study, a slightly greater percentage of patients undergoing non-gynaecological surgery had no nausea and no emesis compared with patients undergoing gynaecological surgery in both the placebo and ondansetron treatment groups. Again, ondansetron 16 mg was the most effective dose in both surgery types. Ondansetron was well tolerated, with only headache being reported as a significant problem in both studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Multicenter Study Clinical Trial
Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting.
Postoperative nausea and vomiting continues to pose problems for surgical patients. Three studies were undertaken to evaluate the efficacy and safety of prophylactic intravenous ondansetron in male and female patients undergoing outpatient surgery. Studies 1 and 2 included a total of 1169 female patients scheduled to undergo surgery on a day case basis. ⋯ In study 3, ondansetron 4 mg was significantly (p < or = 0.001) more effective than placebo in preventing emesis in males. There were no differences between treatment groups with respect to vital signs, laboratory values, or adverse events. Intravenous ondansetron is safe and effective at preventing postoperative nausea and vomiting in male and female patients undergoing day case surgery.
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Randomized Controlled Trial Clinical Trial
Intra-articular morphine and bupivacaine analgesia after arthroscopic knee surgery.
We assessed the effectiveness of intra-articular solutions of morphine, bupivacaine with adrenaline and a combination of both, compared with placebo in facilitating mobilisation and reducing postoperative pain and analgesic requirements for 24 h after operation. Forty patients undergoing arthroscopic knee surgery were studied in a double-blind, randomised, controlled trial. ⋯ Morphine alone provided the best analgesia and significantly decreased analgesic consumption for 24 h after surgery. We conclude that 1 mg of intra-articular morphine provides effective pain relief following arthroscopic knee surgery and that the addition of bupivacaine is of no benefit.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain relief in children. A comparison between caudal bupivacaine and intramuscular diclofenac sodium.
Two hundred and fifty children undergoing herniotomy or orchidopexy under general anaesthesia were randomly allocated to receive pre-operatively either diclofenac sodium 1 mg.kg-1 given intramuscularly or a caudal injection of bupivacaine 0.25% 1 ml.kg-1 with or without adrenaline or no analgesia. Plasma diclofenac and beta-endorphin concentrations were determined in eight and 21 patients respectively. Postoperative pain was assessed by ward nurses who were blinded to the group allocation. ⋯ Caudal analgesia abolished the stress-induced increase in plasma beta-endorphin level which was found in the children given diclofenac and in those who served as controls. Total plasma clearance of intramuscular diclofenac sodium appears to be higher in children than in adults. A single intramuscular dose of diclofenac significantly reduces the need for an opioid analgesic in children after inguinal herniotomy or orchidopexy, and owing to its long duration of action, it offers an alternative or complementary method of pain relief to caudal analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural bupivacaine for aortic surgery. The effect of dilution on the quality of analgesia.
Twenty patients undergoing elective abdominal aortic aneurysm repair were randomly allocated to two groups and studied for 24 h following surgery. Postoperative analgesia was provided by epidural bupivacaine infusion and intravenous patient-controlled 0.05 mg boluses of alfentanil. ⋯ Patients receiving 7 ml.h-1 of epidural infusate required more doses of alfentanil (median 26.5, range 0-50) than the group receiving 25 ml.h-1 of the dilute infusion (median 3.0, range 0-16). It is concluded that 17.5 mg.h-1 of bupivacaine infused into the epidural space produces better analgesia when infused in a volume of 25 ml.h-1 (0.07%) than when given in a volume of 7 ml.h-1 of solution (0.25%).