Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous infusion epidural analgesia in obstetrics. A comparison of 0.08% and 0.25% bupivacaine.
The effects of 0.08% (Group A) and 0.25% (Group B) solutions of bupivacaine were compared in a random manner, to assess continuous pump infusion epidural analgesia in labour. Both solutions were infused at a dose rate of 20 mg bupivacaine/hour. The results in all the mothers who had received infusions lasting more than 4 hours were studied. ⋯ The mean of the intervention-free intervals was significantly greater in Group A than in Group B, and significantly fewer top-up injections were required in Group A. The results show that the administration of a 0.08% solution of bupivacaine into the epidural space by continuous pump infusion is more labour saving than the infusion of a 0.25% solution. The concept that a greater volume infusion rate maintains a more extended liquid sleeve of local anaesthetic in the epidural space is supported.
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A three-week-old girl presented for surgery for congenital pyloric stenosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with atracurium. ⋯ There was no previous exposure to either drug and no definite family history of allergy. Analysis of subsequent sequential blood samples indicated that the reaction mechanism was non-immune and was presumed to be due to pharmacological release of histamine.
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Comparative Study
Longterm treatment with epidural opioids. A retrospective study comprising 150 patients treated with morphine chloride and buprenorphine.
During a 2-year period, 150 patients were treated with epidural opioids for more than 7 days; 89 received morphine and 61 buprenorphine. In 16 cases, medication was changed from morphine to buprenorphine, and in 6 from buprenorphine to morphine. In 19 patients in each group, the disease process was benign. ⋯ Side effects were reported in 46% of patients given morphine and 20% given buprenorphine. Seventy-one patients were treated on an outpatient basis. In these cases, buprenorphine was administered for 89% of the total duration of treatment and morphine chloride for 52%.