British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine.
Ninety-one patients were allocated randomly to three groups to receive 1% ropivacaine 10 ml, 0.5% ropivacaine 20 ml or 0.5% bupivacaine 20 ml extradurally. Intermittent sensory (pinprick) and motor (Bromage scale) assessments of the block produced were recorded, with an assessment of the quality of the block and the requirement for supplementary analgesia. There was little difference between the groups in frequency, onset, duration or spread of sensory block. ⋯ Cardiovascular changes were similar in all three groups. The peak plasma concentration of ropivacaine was significantly greater and T1/2 significantly shorter than those of bupivacaine, although no patient showed any features of systemic toxicity. The systemic kinetics of ropivacaine were not influenced significantly by varying the concentration or volume administered.
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Randomized Controlled Trial Comparative Study Clinical Trial
Addition of morphine to intra-articular bupivacaine does not improve analgesia after day-case arthroscopy.
We conducted a randomized, double-blind, controlled study in patients undergoing day-case knee arthroscopy to evaluate the analgesic effect, for 36 h after operation, of the addition of either 2 mg or 5 mg of morphine to intra-articular bupivacaine. Patients in group BM5 (n = 20) received 0.25% bupivacaine 40 ml with morphine 5 mg; patients in group BM2 (n = 20) received 0.25% bupivacaine 40 ml with morphine 2 mg and patients in group B0 (n = 18) received 0.25% bupivacaine 40 ml only. ⋯ There were no significant differences in pain scores, consumption of additional analgesia, or time to first request for analgesia between any of the groups. We conclude that, after day-case knee arthroscopy, no additional analgesic effect was afforded by the addition of morphine to intra-articular bupivacaine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different bolus doses of morphine for patient-controlled analgesia in children.
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. ⋯ There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative extradural analgesia in children: comparison of morphine with fentanyl.
We have compared the efficacy and side effects of extradural morphine with extradural fentanyl for postoperative pain relief. Thirty children (ages 1-16 yr) were allocated randomly to receive, after extradural administration of 0.5% bupivacaine 0.75 ml kg-1 and before surgical incision, extradural morphine 0.75 microgram kg-1 (group M), with an additional dose administered 24 h later or extradural fentanyl 2 micrograms kg-1 (group F) followed by a continuous extradural infusion (during 48 h). There was no major complication (respiratory depression). ⋯ Pruritus, nausea and vomiting were less common with extradural fentanyl (20% vs 53%, P < 0.05 and 0% vs 33%, P < 0.05) than with morphine. Urinary retention occurred with equal frequency (25%) in the two groups. After a bolus of 2 micrograms kg-1, continuous extradural infusion of fentanyl 5 micrograms kg-1 day-1 provided analgesia comparable to that from a daily bolus of extradural morphine 0.75 mg kg-1 and produced fewer side effects.
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Randomized Controlled Trial Clinical Trial
Memory for auditory material presented during anaesthesia.
We have assessed postoperative memory for lists of 10 neutral words, presented by tape recording, in patients anaesthetized by a standardized technique comprising thiopentone 5 mg kg-1, midazolam 0.07 mg kg-1, fentanyl 3 micrograms kg-1 and 70% nitrous oxide in oxygen, using both free recall and a test in which the subject was asked to indicate the presented words from a larger list. Twenty-four patients were exposed to one of four tape-recorded lists of words and 24 were presented with a blank tape. There was no instance of free recall of presented words. Analysis of the responses in the implicit memory test revealed no difference between the performance of the patients who had been exposed to a word list and those who had not.