British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Partial reversal of the effects of extradural clonidine by oral yohimbine in postoperative patients.
Extradural clonidine produces analgesia, with sedation, hypotension and bradycardia, in postoperative patients. This study assessed if oral yohimbine would reverse these side effects. We studied 30 ASA I-II patients undergoing orthopaedic surgery. ⋯ Pain score was measured on a visual analogue scale (VAS); sedation was assessed on a simple scale graded from 0 (awake and alert) to 3 (deeply sedated, awakening after tactile stimulations) and heart rate and arterial pressure were monitored for 5 h. Yohimbine reversed the sedation induced by extradural clonidine, but also shortened the duration of analgesia (31 (SD 15) min, 186 (72) min and 126 (52) min in the placebo, extradural clonidine and extradural clonidine+yohimbine groups, respectively) (P < 0.05), and did not reduce the hypotension and bradycardia related to clonidine administration. These results suggest that alpha 2 adrenoceptors are mediators of the sedation induced by clonidine and that the haemodynamic effects are not related to stimulation of supraspinal alpha 2 receptors.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The pressor response to venous cannulation: attenuation by prior infiltration with local anaesthetic.
We have compared the cardiovascular response to insertion of an 18-gauge venous cannula in 40 healthy patients. In 20 of the patients, cannulation was preceded by infiltration of local anaesthetic. ⋯ We conclude that there is a significant pressor response to venous cannulation which is obtunded by prior infiltration with local anaesthetic. We recommend, therefore, that s.c. injection of lignocaine should be considered before insertion of an i.v. cannula, especially in the high risk patient.
-
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.
-
Randomized Controlled Trial Comparative Study Clinical Trial
IV anaesthesia with propofol using a target-controlled infusion system: comparison with inhalation anaesthesia for general surgical procedures in children.
We studied 40 children undergoing general surgical procedures. They were allocated randomly to receive induction of anaesthesia with propofol 3-5 mg kg-1 followed by maintenance with halothane and an appropriate regional block, or induction and maintenance of anaesthesia with a computerized, target-controlled infusion of propofol with a regional block. ⋯ There were no significant differences between the groups in heart rate, mean arterial pressure and end-expired carbon dioxide concentration during anaesthesia. There was no significant difference in the recovery times of the two groups.