British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Ketorolac as a component of balanced analgesia after thoracotomy.
Ketorolac 10 mg or 30 mg i.m., 6 hourly or placebo was given to 75 patients who had undergone thoracotomy, in a randomized double-blind study. All subjects were given intercostal nerve blocks with bupivacaine and had access to i.v. patient-controlled morphine. I.m. ketorolac improved the success rate of the analgesic regimen, with fewer patients withdrawing from the study because of inadequate pain relief.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of percutaneous anaesthesia for venous cannulation after topical application of either amethocaine or EMLA cream.
We have compared, in a double-blind study, the efficacy of topical amethocaine cream 1 g (5% w/w) in alleviating the pain of venous cannulation with that of 5% EMLA cream 2.5 g. One hundred and twenty unpremedicated female patients undergoing minor gynaecological surgery, were allocated randomly to one of four groups: 5% EMLA cream 2.5 g for 30 min: 5% EMLA cream 2.5 g for 60 min; amethocaine cream 1 g (5% w/w) for 30 min; amethocaine cream 1 g (5% w/w) for 60 min. ⋯ In addition, a blinded observer assessed the patient's response to venous cannulation using a four-point rank score. Good analgesia was obtained in all groups and there was no statistically significant difference in pain scores between the groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Speed of onset of sensory block for elective extradural caesarean section: choice of agent and temperature of injectate.
We have studied the effects of choice of local anaesthetic and temperature of extradural injectate on speed of onset of sensory block for elective extradural Caesarean section in a double-blind trial in 120 women allocated randomly to one of four groups to receive either plain 0.5% bupivacaine or 2% lignocaine with 1:200,000 adrenaline at either room temperature or 38 degrees C. The onset time of lignocaine with adrenaline was shorter than that of bupivacaine regardless of temperature (P < 0.01). Warmed lignocaine produced the most rapid block overall (P < 0.025). The incidence of hypotension, ephedrine requirement, shivering, quality of analgesia and additional analgesic requirements were similar for all groups.
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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.