Anaesthesia
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We report a case where two consecutive blood patches failed to relieve postdural puncture headache and hearing loss following inadvertent dural puncture. Initial conservative therapy with analgesics, fluids and later two blood patches had no effect and the patient's symptoms only resolved after an epidural dextran 40 patch performed 8 weeks after the dural tap. Two months later, the patient is still asymptomatic.
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The McCoy laryngoscope undoubtedly improves the view of the vocal cords during difficult tracheal intubation. An inherent design problem with the McCoy blade is the need to relax the grip on the laryngoscope handle at the point when stability is most necessary. A new hinged tip blade is described which is operated by a button mechanism on a secondary handle that runs adjacent to the standard handle. This modification offers the possibility of better stability and ease of manipulation whilst maintaining all the benefits of the McCoy blade.
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Randomized Controlled Trial Comparative Study Clinical Trial
The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil.
We compared the duration of analgesia produced by a mixture of lignocaine and bupivacaine, either alone or combined with morphine (75 micrograms.kg-1), buprenorphine (3 micrograms.kg-1) or sufentanil (0.2 microgram.kg-1) in 80 patients after brachial plexus block for orthopaedic surgery of the upper limb. The characteristics of analgesia were evaluated hourly using a visual analogue scale. ⋯ The median duration (range) of satisfactory analgesia was: 11.5 (8-15) h without an opioid, 21 (9-27) h with morphine, 20 (14-34) h with buprenorphine and 24.5 (11-38) h with sufentanil. We conclude that the addition of an opioid to a local anaesthetic mixture lengthens the duration of analgesia.