British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Prospective, controlled, double-blind study of i.v. tenoxicam for analgesia after thoracotomy.
We have shown that a single i.v. dose of tenoxicam 20 mg, after thoracotomy, when compared with placebo in 20 patients (with one exclusion), was associated with a reduction in consumption of papaveretum, assessed by patient-controlled analgesia, of 2.2 mg h-1 (22%) to 4 h and 1.4 mg h-1 (23%) to 12 h after operation (repeated measures analysis of variance: P less than 0.01). There was no reduction from 12 to 24 h. There was no significant difference between groups in pain scores or in side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of extradural administration of sufentanil, morphine and sufentanil-morphine combination after caesarean section.
We have studied postoperative analgesia and unwanted side effects of a single dose of a mixture of morphine and sufentanil administered extradurally with the effects produced by extradural injection of each opioid alone in 64 patients after Caesarean delivery. The patients were allocated randomly to receive morphine 4 mg (n = 21), sufentanil 50 micrograms (n = 22) or morphine 2 mg with sufentanil 25 micrograms (n = 21) via an extradural catheter in a double-blind design. Intensity of pain was measured using a linear visual analogue scale. ⋯ There were no significant changes in cardiorespiratory variables in any group. Side effects consisted mainly of pruritus and nausea and did not differ between groups, with the exception of early and transient dizziness which was observed only in patients given sufentanil either alone or in combination with morphine. We conclude that a single extradural injection of morphine and sufentanil combines the short onset time produced by sufentanil and the long duration of analgesia attributable to morphine, thus providing excellent and prolonged analgesia after Caesarean delivery.
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Comparative Study
Transoesophageal pulsed wave Doppler measurement of cardiac output during major vascular surgery: comparison with the thermodilution technique.
We measured cardiac output in 12 patients undergoing elective abdominal vascular surgery at specific times during the procedure with simultaneous thermodilution and transoesophageal pulsed Doppler echocardiographic techniques. No patient had clinical evidence of valvular heart disease before surgery. ⋯ However, in the seven patients with no evidence of mitral regurgitation, closer agreement (bias 0.14 litre min-1) and narrower limits (+1.6 to -1.3 litre min-1) were observed. We conclude that, in patients with competent mitral valves, transoesophageal echocardiograph may provide accurate determination of cardiac output.
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Randomized Controlled Trial Comparative Study Clinical Trial
Colloid (3% Dextran 70) with or without ephedrine infusion for cardiovascular stability during extradural caesarean section.
Using a non-invasive cardiac output monitor (Bo-Med NCCOM 3-R7), we have compared cardiovascular responses, degree of haemodilution and incidence of nausea during extradural Caesarean section in healthy non-labouring mothers given either ephedrine 17.5 mg and 3% Dextran 70 7.5 ml kg-1 before delivery (group A) or volume loading with Dextran 15 ml kg-1 without infusion of ephedrine (group B). Smallest systolic arterial pressures before delivery were 114 (SEM 4) mm Hg (group A) and 105 (5) (group B). There were no significant differences between the groups in mean arterial pressure, heart rate, systemic vascular resistance or central venous pressure, while cardiac output increased more with the ephedrine infusion (P less than 0.05). ⋯ Ephedrine infusion was associated with a smaller incidence of nausea (P less than 0.01). Umbilical arterial pH values were not different between the two groups. We conclude that infusion of ephedrine, combined with low volume colloid administration, is a safe alternative to more extensive colloid volume expansion for control of hypotension and provides effective prophylaxis against nausea during extradural Caesarean section in healthy non-labouring mothers.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketorolac trometamol for postoperative analgesia after orthopaedic surgery.
We have compared the postoperative morphine requirements and analgesic efficacy of four doses of i.m. ketorolac 30 mg administered 6-hourly with placebo in a double-blind study of patients undergoing major or minor orthopaedic surgery. During the 24-h postoperative study period which began at the end of surgery, patients were prescribed i.m. morphine 10 mg as required 2-hourly and assessments were made of pain at 4 and 24 h. After major surgery, the median morphine consumption over 24 h was 10 mg in patients who received ketorolac, compared with 30 mg in those who received placebo (P = 0.008). ⋯ In the minor surgery groups, median morphine consumption was 0 mg in patients who received ketorolac, compared with 10 mg in those given placebo (ns). Visual analogue pain scores at 24 h after surgery were significantly less in patients who had received ketorolac compared with placebo (P = 0.046) and the overall assessment of pain relief was better in the ketorolac group (P = 0.0007). Mandatory administration of ketorolac appeared to be of benefit in both major and minor orthopaedic surgery, although the principal effects were reduction in requirement for supplementary morphine for major surgery and better overall analgesia for minor surgery.