British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Efficacy of continuous intercostal bupivacaine for pain relief after thoracotomy.
We studied 20 patients undergoing thoracotomy, in a double-blind, placebo-controlled crossover trial of intercostal bupivacaine. Bupivacaine 0.25% was infused at 5 ml h-1 through each of two catheters placed in the intercostal space at operation. ⋯ There were no adverse effects related to the intercostal infusion of bupivacaine. We conclude that bupivacaine, infused through catheters placed during thoracotomy in the adjacent intercostal spaces, is a useful adjunct to systemic opioid analgesia.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Patient-controlled extradural analgesia to compare bupivacaine, fentanyl and bupivacaine with fentanyl in the treatment of postoperative pain.
We have assessed the effect of combining extradural bupivacaine and fentanyl in 60 orthopaedic patients who received 0.125% bupivacaine (bupivacaine group), fentanyl 5 micrograms ml-1 (fentanyl group), or 0.125% bupivacaine combined with fentanyl 5 micrograms ml-1 (combined group), delivered by patient-controlled extradural analgesia for 24 h via a lumbar extradural catheter. Adding bupivacaine to fentanyl reduced mean (SD) fentanyl administration from 117 (46) ml to 89 (42) ml (P < 0.005). Adding fentanyl to bupivacaine reduced mean bupivacaine administration from 113 (46) ml to 89 (42) ml (P < 0.05). ⋯ The mean pain score was greater also for knee replacement (16 (10) mm) than for hip replacement (10 (9) mm) (P < 0.05). We conclude that extradural bupivacaine and fentanyl were additive in their analgesic actions, resulting in decreased requirements of each individual agent. Knee replacement was found also to be more painful than hip replacement after operation.
-
Flow-volume and pressure-volume loops were measured with continuous spirometry in 49 patients in whom the trachea was intubated "blindly" with a double-lumen endobronchial tube for thoracic surgery. Nineteen endobronchial tubes were malpositioned by fibreoptic bronchoscopic criteria; 63% of these were suspected because of the configuration of the spirometric loops. ⋯ The secondary displacements were identified by abnormal loop configurations and confirmed with fibreoptic bronchoscopy. Continuous spirometric monitoring is helpful in detecting endobronchial tube displacement during intubation and surgery.
-
In 20 adult patients (18 male) who presented for thoracotomy, the trachea was intubated using Mallinckrodt disposable double-lumen tubes (18 large and two medium). The endobronchial cuff was inflated by a trained operating department assistant using an air-filled syringe. ⋯ Mean initial cuff pressure was 69.3 (SEM 6.0) mm Hg, whereas the mean minimum cuff pressure was 29.5 (4.0) mm Hg (P < 0.0001). The results suggest that the method described of inflating the endobronchial cuff may lead to overinflation and subsequent excessive pressure on the endobronchial wall.