Ann Acad Med Singap
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialSingle-blind comparative analgesic and safety study of single doses of intramuscularly administered ketorolac tromethamine and pethidine hydrochloride in patients with pain following orthopaedic surgery.
Ketorolac tromethamine, a potent non-narcotic prostaglandin synthetase inhibiting analgesic was compared with pethidine for relief of moderate to severe postoperative pain. Forty-eight patients received Ketorolac 0.5 mg/kg and 52 received pethidine 1.25 mg/kg. The degree of pain prior to the administration of the drug and pain relief that followed were quantified using a vertical visual analogue scale (VAS) and monitored at hourly intervals. ⋯ The incidence of side effects was significantly greater with pethidine (40.4%) as compared to Ketorolac (10.4%). The similar analgesic efficacy to pethidine makes Ketorolac an appropriate drug for the relief of postoperative pain especially in day surgery settings where observation following administration of the drug as in the case of pethidine can be dispensed with and patients sent home earlier because of the minimal side effects associated with its use. Caution must be exercised with the use of large doses of Ketorolac especially if the drug is used for more than 5 days to avoid serious complications like renal failure and gastrointestinal bleeding.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialEpidural infusions of bupivacaine and fentanyl do not improve rehabilitation following one-stage bilateral total knee arthroplasty.
Epidural analgesia with local anaesthetic minimizes the catabolic response to surgery. To determine whether this could enhance the rate of recovery following orthopaedic surgery, 51 patients undergoing bilateral one-stage total knee arthroplasty were allocated to receive infusions of either continuous epidural bupivacaine/fentanyl or continuous intravenous fentanyl to compare the efficacy of these modes of pain relief on postoperative clinical outcomes and rates of rehabilitation. ⋯ Postoperatively, pain relief (visual analogue scale), attainment of physical therapy goals and cardiopulmonary complications were measured daily for 7 days. Epidural analgesia with a combination of bupivacaine and fentanyl did not result in any measurable improvement in rehabilitation milestones or reduction in postoperative complications following bilateral total knee arthroplasty than with fentanyl infusions alone.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Clinical TrialCombination of intramuscular Ketorolac and low dose epidural morphine for the relief of post-caesarean pain.
Epidural morphine produces profound analgesia but also causes many adverse effects in a dose-dependent manner. This double-blind, randomized, prospective study evaluated the analgesic efficacy and safety of low dose (2 mg) epidural morphine in combination with 30 mg intramuscular (IM) Ketorolac, a non-steroidal anti-inflammatory drug with potent analgesic activity, in patients suffering pain after caesarean surgery. Ninety parturients who received epidural anaesthesia in the postoperative period were divided into 3 equal groups: group A received epidural morphine 2 mg plus IM placebo; group B received epidural morphine 2 mg plus IM Ketorolac 30 mg; and group C received epidural saline placebo plus IM Ketorolac 30 mg. ⋯ Results showed that group B had statistically significant superior pain relief to that of the other 2 groups. The incidence of adverse effects was similar between those of group A and B. We concluded that the addition of Ketorolac by IM administration enhanced the analgesic effect of low dose (2 mg) epidural morphine in the relief of post-caesarean pain without potentiating its adverse effects.
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Ann Acad Med Singap · Nov 1994
ReviewRecent advances in the understanding and management of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) is a common distressing complication of surgery and anaesthesia. The multifactorial aetiology of PONV gives rise to an incidence that varies widely among different patient groups. ⋯ Current research is concentrated on a new class of drugs, the serotonin (5-HT3) receptor antagonists. This review summarizes the experience with these drugs and other recent advances in PONV.