British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of pre- vs postoperative inguinal field block on postoperative pain after herniorrhaphy.
The analgesic effects of an identical inguinal field block, performed before or immediately after inguinal herniorrhaphy, were evaluated in 32 healthy patients in a double-blind, randomized study. During surgery, all patients received a light general anaesthesia with thiopentone, alfentanil and nitrous oxide in oxygen. After induction of general anaesthesia, patients were allocated randomly to receive an inguinal field block with lignocaine, either 15 min before operation or immediately after operation, after closure of the surgical wound, but before the patients were awake. ⋯ No significant differences between the groups were observed in VAS scores or verbal pain scores during rest or ambulation at any time. There was no significant difference in time to first request for morphine or total morphine consumption. These results do not show pre-emptive analgesia with a conventional inguinal field block to be of clinical importance compared with a similar block administered after operation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery from day-case anaesthesia: comparison of total i.v. anaesthesia using propofol with an inhalation technique.
A prospective, double-blind study was conducted to compare postoperative recovery after either total i.v. anaesthesia (TIVA: propofol and alfentanil) or an inhalation technique (propofol and alfentanil followed by nitrous oxide and isoflurane) in 50 patients undergoing day-case gynaecological surgery. Psychomotor performance was assessed at 1 and 2 h after surgery using the Critical Flicker Fusion Threshold (CFFT), Simple Reaction Time (SRT) and Choice Reaction Time (CRT). Subjective recovery and side effects after discharge from hospital were assessed using a postal questionnaire. Recovery occurred significantly earlier in the TIVA group as assessed by CFFT and SRT (P less than 0.01); there were no significant differences (P greater than 0.05) between the two groups in CRT, subjective duration of recovery or side effects.
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Comparative Study
Response of 10 pulse oximeters to an in vitro test system.
Pulse oximeters are often used in situations in which severe hypoxaemia may occur. We have developed an in vitro system to test the accuracy of pulse oximeter calibration. ⋯ The oximeters tested varied widely in their accuracy and linearity. We conclude that the system can test the accuracy, reproducibility and linearity of response of pulse oximeter readings at low oxyhaemoglobin saturations.
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Fentanyl and bupivacaine were tested for their stability when diluted with 0.9% sodium chloride to 4 micrograms ml-1 and 0.1% respectively, in 100-ml polyvinyl chloride (PVC) bags, alone and in combination, with and without adrenaline 1:200,000. Changes in drug concentration and pH were investigated for 56 days. The combination of fentanyl, bupivacaine and adrenaline was tested under varying environmental conditions of 35 degrees C, 4 degrees C, -18 degrees C, room temperature, darkness and after autoclaving. ⋯ Adrenaline was progressively degraded to a maximum reduction of 37.3% at 35 degrees C by day 56. Solutions containing adrenaline became more acidic over 56 days. Fentanyl and bupivacaine were stable.
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A disposable patient-controlled analgesia (PCA) device was evaluated in 20 children after major abdominal, urological and orthopaedic surgery. All patients were given a high dependency level of nursing care in general wards. ⋯ Morphine consumption was similar with the two techniques, but varied widely between patients. The disposable device has a complementary role to play in the provision of a comprehensive pain relief service for children.