British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical and radiological comparison of perivascular and transarterial techniques of axillary brachial plexus block.
The perivascular technique of axillary brachial plexus block results in incomplete block of radial and musculocutaneous nerves in 10-20% of patients. With the transarterial technique and a large dose of mepivacaine, success rates of 99% have been reported. We have compared the clinical efficacy of these techniques in 50 patients using 1% mepivacaine 45 ml with adrenaline. ⋯ There were no statistically significant differences in sensory or motor block between the groups at 20 min or in the plasma concentrations of mepivacaine measured 0-45 min after injection. In the CT scans, both proximal and distal spread of the contrast medium were more common after perivascular than after transarterial block. The distribution of the contrast medium was not related to the efficacy of the block.
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Randomized Controlled Trial Clinical Trial
Improvement in i.v. regional anaesthesia by re-exsanguination before surgery.
A modification of an i.v. regional anaesthesia (IVRA) technique is described in which the arm is re-exsanguinated before surgery (re-IVRA). IVRA and re-IVRA were compared for quality of operative field, sensory and motor block, quality of analgesia and blood concentrations of prilocaine, lignocaine and mepivacaine in a double-blind study in 120 patients undergoing hand surgery. ⋯ Re-exsanguination improved tolerance of the tourniquet. Plasma concentrations in the re-IVRA group showed some increases, but these were not in the toxic range.
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation: comparison between propofol and thiopentone.
We have studied the haemodynamic changes, QT intervals and catecholamine responses to induction of anaesthesia and tracheal intubation in 24 ASA I patients allocated randomly to receive either propofol 2.5 mg kg-1 or thiopentone 5 mg kg-1 over 60 s. After disappearance of the eyelash reflex, the lungs were ventilated with 100% oxygen for 3 min. The trachea was intubated after administration of vecuronium. ⋯ One patient in the thiopentone group with a significantly prolonged QT interval had episodes of bigeminy and ventricular tachycardia. In both groups, concentrations of noradrenaline in mixed venous plasma increased after intubation (P < 0.001). Concentrations of adrenaline increased after intubation only in the thiopentone group (P < 0.001).
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Randomized Controlled Trial Clinical Trial
Diclofenac and ketoprofen for pain treatment after elective caesarean section.
We have studied the effect of a constant infusion of diclofenac 150 mg/24 h, ketoprofen 200 mg/24 h or placebo on postoperative pain after elective Caesarean section performed under spinal or extradural block in 90 patients in a prospective, randomized and double-blind study. During the first 24 h after operation, patients in the treatment groups were more comfortable than the placebo group (P < 0.005); the diclofenac group needed a mean of oxycodone 21.6 mg/24 h and the ketoprofen group 21.2 mg/24 h, compared with 38.3 mg/24 in the placebo group (P < 0.001); the mean time to the first injection of oxycodone was 270.5 min in the diclofenac group, 270.2 min in the ketoprofen group and 161.2 min in the placebo group (P < 0.001). ⋯ One patient in the diclofenac group was eliminated from the study because of uterine relaxation during the first 30 min after start of the drug infusion; this improved after cessation of diclofenac and infusion of sulprostone. There were no other serious side effects.