British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of a 25-gauge Whitacre needle to reduce the incidence of postdural puncture headache.
We studied 200 orthopaedic inpatients (111 males) aged 15-84 yr who received spinal anaesthesia with one of two types of Whitacre spinal needle: 22-gauge or 25-gauge. The incidence of headache, backache, failure of spinal anaesthesia and patient acceptability was investigated using a questionnaire. The incidence of postdural puncture headache (PDPH) was 4% in the 22-gauge group and 2% in the 25-gauge group. ⋯ Spinal anaesthesia was carried out successfully in all patients in both groups. Patient acceptance was high (98%) and there were no serious complications observed. We conclude that spinal anaesthesia is easy to perform with a 25-gauge pencil-point needle and is associated with a low incidence of PDPH.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of plain and alkalinized local anaesthetic mixtures of lignocaine and bupivacaine for elective extradural caesarean section.
We have examined a local anaesthetic mixture of 0.5% bupivacaine 10 ml and 2% lignocaine 10 ml with adrenaline 1 in 200,000, to which 8.4% sodium bicarbonate 2 ml was added, for extradural Caesarean section. The alkalinized mixture of local anaesthetics produced a block of more rapid onset and density than a mixture of bupivacaine and lignocaine alone (P less than 0.001).
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Randomized Controlled Trial Clinical Trial
Pressure support ventilation using a new tracheal gas injection tube.
In order to explore new types of jet ventilation, we tested a tracheal gas injection tube (TGIT) which included six thin capillaries and provided high pressure injection. The driving pressure was chosen to yield a plateau of inspiratory tracheal pressure of 10 cm H2O. An original controller was built to monitor spirometry and trigger injection in order to deliver both pressure controlled ventilation (PCVTGIT) and a new mode of inspiratory pressure support jet ventilation (IPSTGIT). ⋯ IPSTGIT, compared with spontaneous breathing increased minute ventilation (from 5.7 (SD 1.6) to 7.1 (1.7) litre min-1) (P less than 0.001). It reduced the total work of breathing (from 0.625 (0.223) to 0.263 (0.151) J litre-1, respectively) (P less than 0.01) and the occlusion pressure (from 2.62 (1.28) to 1.36 (0.74) cm H2O, respectively) (P less than 0.01). It is concluded that this TGIT used with a specific system for sensing and triggering ventilation allows inspiratory pressure support during low frequency jet ventilation.
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Comparative Study
Comparison of contemporaneous and retrospective assessment of postoperative pain using the visual analogue scale.
We have assessed postoperative pain in 50 patients who had undergone total abdominal hysterectomy, using repeated contemporaneous and single retrospective visual analogue scores. There were significant correlations between the median, mean and greatest contemporaneous scores, and the single retrospective scores, but there was a wide scatter of results among and within individual patients. We conclude that the wide variability between the two methods of assessment suggests that the two techniques should not be used interchangeably.
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Randomized Controlled Trial Clinical Trial
Effect of i.v. low-dose adrenaline and phenylephrine infusions on plasma concentrations of bupivacaine after lumbar extradural anaesthesia in elderly patients.
Thirty patients undergoing primary total hip replacement under lumbar extradural anaesthesia with 0.75% bupivacaine 25 ml were allocated randomly to receive either low-dose adrenaline or phenylephrine infusions i.v. throughout surgery. Haemodynamic measurements and arterial blood samples were obtained before the extradural injection and at 10, 20, 30, 40, 50, 60 and 90 min thereafter. ⋯ Cardiac output was significantly greater in patients receiving adrenaline infusions (P less than 0.01). It is postulated that the smaller circulating concentrations of bupivacaine observed in patients receiving adrenaline were caused by increased cardiac output and a greater volume of distribution than in patients receiving phenylephrine.