Anaesthesia
-
Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide is particularly emetogenic. Older inhalational anaesthetics, such as cyclopropane, are associated with a high incidence, while the currently used agents, isoflurane, enflurane and halothane, cause less, but still significant postoperative nausea and vomiting. ⋯ Furthermore, a previous history of postoperative nausea and vomiting or motion sickness is a known risk factor. Superimposed on this is the type of surgery--abdominal and gynaecological surgery are particularly emetogenic, and the incidence of postoperative nausea and vomiting following strabismus surgery is high. Increased quality of healthcare, and a growing awareness of the importance of patient satisfaction, are providing new incentives to ensure that postoperative nausea and vomiting is dealt with adequately.
-
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.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of postoperative analgesia following spinal or epidural anaesthesia for caesarean section.
Postoperative analgesia, using a patient-controlled analgesia system, was studied in 32 women after elective Caesarean section performed under either spinal or epidural anaesthesia. Patients who had spinal anaesthesia had significantly higher pain scores and morphine consumption during the first 4 h postoperatively than patients who had epidural anaesthesia. ⋯ After 8 h there was little difference in pain scores or morphine use between the two groups. Total morphine consumption in the first 24 h postoperatively was not significantly different between the two groups.
-
Postoperative nausea and vomiting is one of the most common complications of inpatient and day case surgical procedures. In a climate where total cost of an illness is becoming increasingly important, postoperative nausea and vomiting is a major contributor to direct and indirect costs for both the hospital and patient. ⋯ Postoperative nausea and vomiting is perceived by patients to account for equal or more debilitation than surgery itself and may cause them to lose wages due to absence from work. Reducing the incidence of nausea and vomiting and its associated problems may therefore provide opportunities to improve patient care, decrease the size of waiting lists and improve utilisation of scarce healthcare resources.
-
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%).