British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery.
We have undertaken a prospective, randomized comparison of the superficially similar techniques of interpleural and paravertebral (extrapleural) analgesia in 53 patients undergoing posterolateral thoracotomy. Local anaesthetic placed anterior to the superior costotransverse ligament and posterior to the parietal pleura produces a paravertebral block and instilled between the parietal and visceral pleurae produces an interpleural block. Patients received preoperative and postoperative continuous bupivacaine paravertebral blocks in group 1 and interpleural blocks in group 2. ⋯ PFT were significantly better (P = 0.03-0.0001) in group 1, and PORM was lower and hospital stay approximately 1 day less in this group. Five patients in group 2 became temporarily confused, probably because of bupivacaine toxicity (P = 0.02). We conclude that bupivacaine deposited paravertebrally produced greater preservation of lung function and fewer side effects than bupivacaine administered interpleurally.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Onset of neuromuscular block after tourniquet inflation: comparison of suxamethonium with vecuronium.
To determine the influence of circulatory factors on onset of neuromuscular block, we have measured twitch height in an arm with a tourniquet inflated during onset and compared this with data from a control arm in 20 patients under fentanyl-thiopentone-nitrous oxide-isoflurane anaesthesia. Patients were allocated randomly to receive either vecuronium 0.1 mg kg-1 (n = 10) or suxamethonium 1 mg kg-1 (n = 10). The EMG response of the first dorsal interosseous to single twitch stimulation of the ulnar nerve every 10 s was recorded in both arms. ⋯ Maximum block was only 74 (20)% in the tourniquet arm compared with 97 (5)% in the perfused arm (P < 0.05). The difference in maximum neuromuscular block between arms was 4 (3)% in the vecuronium group and 22 (17)% in the suxamethonium group (P < 0.01). We conclude that during onset, neuromuscular block continued to increase in spite of interruption of blood flow, and this increase was greater with vecuronium than with suxamethonium.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of i.m. and local infiltration of ketorolac with and without local anaesthetic.
We have studied postoperative analgesia in 32 patients undergoing outpatient repair of inguinal hernia. All patients received a standardized general anaesthetic of thiopentone followed by halothane or isoflurane in 70% nitrous oxide and oxygen delivered by face mask or laryngeal mask with spontaneous ventilation. No patient received premedication, opioids or neuromuscular blockers. ⋯ There were no significant differences in pain scores at any time between the three study groups. Wound infiltration with ketorolac 30 mg in saline, 0.25% bupivacaine or ketorolac 30 mg with 0.25% bupivacaine provided equivalent analgesia. Wound infiltration with ketorolac 30 mg in saline provided analgesia superior to that of ketorolac 60 mg i.m.
-
Randomized Controlled Trial Comparative Study Clinical Trial
EEG arousal during laryngoscopy and intubation: comparison of thiopentone or propofol supplemented with nitrous oxide.
We studied EEG arousal after laryngoscopy and intubation with standardized bolus induction of anaesthesia. Twenty patients were prospectively allocated randomly to induction with propofol 3 mg kg-1 (n = 10) or thiopentone (6 mg kg-1 (n = 10) and 50% nitrous oxide in oxygen. Neuromuscular block was produced with vecuronium 0.2 mg kg-1 given 30 s after induction. ⋯ This EEG arousal was greater in the thiopentone group, despite the fact that EEG depression was similar to that produced by propofol before laryngoscopy and intubation. Propofol and thiopentone in combination with nitrous oxide had similar cortical depressant effects, but propofol appeared to depress subcortical nociceptive processing more than thiopentone. While the degree of cortical EEG depression seems less useful for predicting reaction to subsequent nociception, EEG arousal reactions may prove suitable for monitoring intra-anaesthetic nociception and its modulation.
-
Randomized Controlled Trial Clinical Trial
Influence of inspired nitrogen concentration during anaesthesia for coronary artery bypass grafting on postoperative atelectasis.
Pulmonary collapse is a common problem after coronary artery bypass graft surgery (CABG). If absorption atelectasis during anaesthesia is an important mechanism in the genesis of pulmonary collapse after CABG, the addition of nitrogen to the inspired gas during anaesthesia should reduce the amount of postoperative collapse. ⋯ Lung volumes, PaO2, and an x-ray atelectasis score were measured before and after surgery to assess the degree of atelectasis. There were no significant differences between the two treatment groups in any of these measurements.