Anaesthesia
-
Two cases are reported of sciatic nerve palsy after delivery by Caesarean section in primigravidae. One mother was slender and had an emergency Caesarean section for failure to progress with a breech presentation. Epidural analgesia during labour was extended for operative delivery. ⋯ She experienced severe intrapartum hypotension. Both patients suffered right sided sciatic nerve palsy. The aetiologies of obstetric palsies and those following regional block are reviewed and the importance of careful diagnosis and of avoiding peripheral nerve compression during regional block are emphasised.
-
Randomized Controlled Trial Clinical Trial
Pretreatment with controlled-release morphine for pain after hysterectomy.
In a double-blind randomised study, two dosing regimens for controlled-release morphine tablets were compared against placebo to ascertain the extent of prophylactic postoperative pain control in 51 women undergoing abdominal hysterectomy. One group of patients received controlled-release morphine every 12 h for 2 days before surgery, a second group received a single dose of controlled-release morphine 2 h before surgery and a third group received placebo. Patient-controlled analgesia system demands were compared for the first 38 h after surgery and 10-point pain scores and McGill pain questionnaires were compared for the first 6 postoperative days and at 6 weeks after surgery. ⋯ Pain scores on the third and fourth postoperative days were significantly lower in those who had a single pre-operative dose of controlled-release morphine compared with placebo and those who had been treated with-morphine every 12 h for 2 days (p = 0.043 and 0.024 for third and fourth day respectively). Patient-controlled analgesia demands were also fewer and less variable in those patients receiving the single dose of morphine 2 h before surgery. The study shows a beneficial analgesic effect of a single pre-operative dose of morphine, but shows no benefit for a more prolonged pre-operative dosing regimen.
-
We describe the effects of accidental intra-arterial injection of suxamethonium and atracurium into the femoral artery of an infant. An 11-month-old boy with Downs Syndrome and obstructive sleep apnoea presented for tonsillectomy. Peripheral venous cannulation proved impossible. ⋯ Within 30 min there was marked vasodilation of both legs with easily felt peripheral pulses. In view of the tonsillectomy anticoagulant and thrombolytic therapy were contra-indicated. There were no adverse sequelae.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of prophylactic ondansetron and metoclopramide administration in patients undergoing major neurosurgical procedures.
In a prospective, randomised, double-blind trial, we assessed the relative efficacy of prophylactic ondansetron and metoclopramide administration in the reduction of postoperative nausea and vomiting in 60 patients undergoing routine major neurosurgical procedures. The patients were randomly allocated into one of two groups. ⋯ Patients who received metoclopramide experienced less postoperative nausea and vomiting than those who received ondansetron in the 48 h following surgery (17 (56%) versus 9 (30%) p = 0.038). In the light of these findings, we believe that ondansetron is an inappropriate agent for the prevention of postoperative nausea and vomiting in the neurosurgical population.
-
Randomized Controlled Trial Clinical Trial
The optimal dose of ketamine for caudal epidural blockade in children.
Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml.kg-1 of 0.25% bupivacaine with 0.25 mg.kg-1 of preservative-free ketamine, group B received 1 ml.kg-1 of 0.25% bupivacaine with ketamine 0.5 mg.kg-1 and group C received 1 ml.kg-1 of 0.25% bupivacaine with 1 mg.kg-1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. ⋯ There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.