Anaesthesia
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The inadequacies of conventional intramuscular opioid analgesia have fueled an expansion in the use of patient-controlled analgesia and epidural analgesia after surgery. This is not always accompanied by increased education and specialist supervision of ward staff and patients. ⋯ Frequent review of patients and regular education of ward staff by a specialist Pain Nurse have achieved a substantial reduction in side effects of epidural analgesia and improvement in efficacy of patient-controlled analgesia. We have shown that the advantages of patient-controlled analgesia can be largely negated by failure to address deficiencies in knowledge of pain management among ward staff and patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate.
We have performed a prospective randomised trial of 30 patients undergoing craniotomy to compare intramuscular codeine phosphate with patient-controlled analgesia using morphine 1 mg bolus with a 10-min lockout and no background infusion. For 24 h postoperatively, pain, nausea, Glasgow coma score, respiratory rate and sedation score were assessed. There was a wide variation in the amounts of morphine requested by the patients in the patient-controlled analgesia group in the first 24 h postoperatively (range 2-79 mg, median 17 mg). ⋯ There were no significant differences between the two groups in respect of nausea and vomiting, sedation score or respiratory rate. No major adverse effects were noted in either group. Patient-controlled analgesia with morphine is an alternative to intramuscular codeine phosphate in neurosurgical patients which merits further investigation.
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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.
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Randomized Controlled Trial Clinical Trial
Pre-operative oral administration of morphine in day-case gynaecological laparoscopy.
The analgesic effect of morphine sulphate 10 mg by mouth given pre-operatively on pain after gynaecological laparoscopy was studied in a randomised, prospective, double-blind, placebo-controlled comparison. Two groups of 56 patients were studied one group undergoing diagnostic laparoscopy and the other laparoscopic sterilisation. ⋯ Morphine premedication did not significantly influence postoperative pain as assessed on a visual analogue scale in either group and postoperative opioid consumption was unaffected. Premedication with morphine 10 mg orally does not significantly decrease pain after day-case gynaecological laparoscopy.
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Randomized Controlled Trial Clinical Trial
Gas leakage and the laryngeal mask airway. A comparison with the tracheal tube and facemask during spontaneous ventilation using a circle breathing system.
The ability of the laryngeal mask airway, tracheal tube and facemask to provide a leak free seal in a clinical setting was assessed by measuring the minimal fresh gas flows needed in a closed circle system during spontaneous ventilation on 60 subjects. The fresh gas flow was reduced until no spillage occurred from the pop-off valve. This fresh gas flow was taken to represent the sum of gas uptake by the subject and gas leakage from the circuit. ⋯ The fresh gas flow required for the facemask group was significantly higher than that for the laryngeal mask airway or tracheal tube groups (p < 0.01). There was no significant difference between the fresh gas flows required for the tracheal tube and laryngeal mask airway group. We conclude that the laryngeal mask airway provides as good a gas tight seal as a tracheal tube in this context and would be of benefit in reducing anaesthetic gas pollution.