British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Transcutaneous electrical nerve stimulation in the management of acute postoperative pain.
Twenty patients undergoing decompressive lumbar laminectomy were randomly allocated, in a double-blind manner, to receive active or inactive transcutaneous electrical nerve stimulation (TENS) as part of the management of their postoperative pain. All patients received the same non-narcotic general anaesthetic. The efficacy of the TENS was assessed by using a patient-controlled analgesia system (PRODAC) which delivered morphine i.v. ⋯ In addition, plasma morphine concentrations were measured hourly for the first 6 h and again at 24 h. There was no statistical difference between the two groups in the number of patient demands for analgesia, morphine dose or plasma morphine concentration. TENS offered no advantage over a placebo in the management of acute postoperative pain in these patients.
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Comparative Study
Potency of atracurium and vecuronium at the diaphragm and the adductor pollicis muscle.
Train-of-four stimulation was applied to the ulnar and phrenic nerves in 18 adult patients anaesthetized with nitrous oxide and halothane in oxygen. The response of the adductor pollicis and the diaphragm were measured. Incremental doses of atracurium and vecuronium were given, with an infusion to replace drug lost by elimination or distribution. ⋯ The mean (SEM) ED50 ratios were 1.56 (0.16) for atracurium and 1.47 (0.16) for vecuronium. ED90 ratios were 1.93 (0.29) and 1.55 (0.17) for atracurium and vecuronium, respectively. It is concluded that both atracurium and vecuronium exhibit a similar degree of sparing of the diaphragm.
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Ten obstetric patients received 17-20 ml of autologous blood through an extradural catheter after inadvertent dural puncture. The time interval from dural puncture to prophylactic extradural blood patch ranged from 90 to 660 min. One of the 10 patients developed a mild occipital headache, which required no further intervention.
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Randomized Controlled Trial Comparative Study Clinical Trial
Maternal inspired oxygen concentration and neonatal status for caesarean section under general anaesthesia. Comparison of effects of 33% or 50% oxygen in nitrous oxide.
The relationship between maternal FIO2 and umbilical venous PO2, PCO2, pH and neonatal Apgar and TSR (time to sustained respiration) scores was studied in 35 patients undergoing Caesarean section under general anaesthesia. Patients were allocated randomly to breathe an FIO2 of either 0.5 or 0.33. ⋯ No differences were found between groups for 1- or 5-min Apgar scores or TSR values. It is concluded that no difference in fetal outcome or acid-base status can be detected when maternal FIO2 is decreased from 0.5 to 0.33, and that the use of 33% oxygen in 66% nitrous oxide appears to be safe for neonates who have not suffered fetal distress before delivery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral nalbuphine for the treatment of pain after dental extractions.
A randomized, double-blind comparison of nalbuphine 30 mg or 60 mg by mouth and dihydrocodeine 30 mg by mouth was conducted in 75 patients with moderate to severe pain after surgery for dental extractions under general anaesthesia. A significant reduction in pain intensity followed each treatment and persisted throughout the 4-h observation period after nalbuphine, but only for 3 h after dihydrocodeine was given. ⋯ However, the patients who received nalbuphine 30 mg had a significantly higher mean pain intensity before treatment than those in the other groups. The side-effects encountered were those typical of opioid medication; there were no statistically significant differences between the groups.