British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of ketamine-midazolam with those of fentanyl-midazolam on cortical somatosensory evoked potentials during major spine surgery.
Cortical somatosensory evoked potentials (CSEP) allow monitoring of spinal cord function during surgery. Ketamine has been shown to enhance CSEP amplitude, but there is no previous study comparing its effects with those of other anaesthetic regimens. Therefore, we have compared the effects of ketamine with those of fentanyl, both combined with midazolam, on CSEP monitoring during major spine surgery. ⋯ Nevertheless, we did not observe any significant differences in amplitudes or latencies between the two groups. The delay in obtaining the first voluntary postoperative motor response was significantly greater in the ketamine group (170 (54) vs 55 (17) min, P < 0.01). Both ketamine and fentanyl allowed us to obtain reliable CSEP during major spine surgery, and there were no significant difference between these two anaesthetic regimens for CSEP monitoring, but a longer delay for voluntary postoperative motor assessment was observed in the ketamine group.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hyaluronidase and peribulbar block.
We have assessed the effect of two concentrations of hyaluronidase on the quality of peribulbar block, using a low volume, single injection technique. We studied 200 patients undergoing elective intraocular surgery, allocated randomly to one of three groups. Group 1 (n = 50) received peribulbar block with 5 ml of a 1:1 mixture of 0.5% plain bupivacaine and 2% plain lignocaine. ⋯ The incidence of satisfactory block at 5 min was increased in both groups given hyaluronidase (group 2, P < 0.05; group 3, P < 0.001). There were no significant differences between groups 2 and 3 with respect to quality of block at 5 min. Hyaluronidase in both concentrations improved the quality of peribulbar block at 5 min, and when used in a concentration of 300 iu ml-1, also improved the speed of onset of block.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Continuous extradural infusion of ropivacaine 2 mg ml-1 for pain relief during labour.
We have assessed the dose-response relationship of a solution of ropivacaine 2 mg ml-1, given as a continuous extradural infusion to women in labour. A total of 133 parturients were allocated randomly to one of four groups to receive a fixed rate ropivacaine infusion of 4, 6, 8 or 10 ml h-1 with additional bolus doses as necessary. ⋯ There were no significant differences between groups in terms of obstetric or neonatal outcome. We conclude that ropivacaine 2 mg ml-1 was effective and well tolerated when given as a continuous extradural infusion at 6-8 ml h-1 and may be used as the sole analgesic during labour.
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Randomized Controlled Trial Clinical Trial
Intrathecal infusion of bupivacaine with or without morphine for postoperative analgesia after hip and knee arthroplasty.
Postoperative pain after major orthopaedic operations can be controlled by continuous intrathecal administration of opioids or local anaesthetics. Effective intrathecal analgesia can be achieved through synergism of low doses of the two analgesic drugs and, possibly, less drug-related adverse effects. Therefore, we have evaluated the usefulness of a combined low-dose bupivacaine and morphine infusion in patients undergoing hip and knee arthroplasty. ⋯ One patient in the same group had minor decubitus on the heel of the operated leg, probably because of prolonged motor block. We conclude that intrathecal infusion of a combination of bupivacaine 1 mg h-1 and morphine 8 micrograms h-1 produced adequate postoperative analgesia. Unfortunately, postoperative nausea and vomiting was a frequent disturbing adverse effect.