AANA journal
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of motor block between ropivacaine and bupivacaine for continuous labor epidural analgesia.
The aim of the present study was to compare the amount of motor block produced by different loading doses of ropivacaine and bupivacaine when delivered in a dilute solution with added opioid. Sixty-eight healthy term primigravid parturients were randomized to receive an initial bolus dose of 10 mL of 1 of the following: 0.25% bupivacaine (high bupivacaine), 0.25% ropivacaine (high ropivacaine), 0.125% bupivacaine (low bupivacaine), or 0.125% ropivacaine (low ropivacaine). Each loading dose had 10 micrograms of sufentanil added to it. ⋯ A statistically significant greater percentage of parturients receiving bupivacaine had motor block than those who received ropivacaine, with a marked decrease in the occurrence of motor block in the low ropivacaine group. The pain relief seemed to be less satisfactory in the ropivacaine groups, but the difference was not statistically significant. Ropivacaine produced significantly less motor block than bupivacaine in the 0.25% and the 0.125% loading doses, with the greatest difference seen in the lower concentration loading dose of ropivacaine.
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Randomized Controlled Trial Clinical Trial
Does ketorolac produce preemptive analgesic effects in laparoscopic ambulatory surgery patients?
The purpose of this study was to determine whether intravenous ketorolac tromethamine could produce preemptive analgesia in patients undergoing laparoscopic gynecologic surgical procedures. Each patient's response to pain was measured by the mechanical visual analogue scale (M-VAS) and total analgesic use. By using a double-blind design, 49 patients were randomized into the preemptive group (n = 25), which received ketorolac preoperatively, or the control group (n = 24), which received ketorolac at the conclusion of surgery. ⋯ Only the pain change from baseline between the 2 groups was statistically significant. Total fentanyl use and postoperative oral analgesic use was not statistically significant. Clinically, the preemptive administration of ketorolac to patients undergoing laparoscopic gynecologic surgery did not demonstrate preemptive analgesic effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Induction pain perception after premedication with propofol vs lidocaine: a pilot study.
Propofol, an intravenous (i.v.) sedative-hypnotic agent, is commonly used for the induction of general anesthesia. It has, however, a substantial potential for causing burning pain at the i.v. site. Several preinduction pharmacologic agents are used routinely to blunt or diminish this burning sensation. ⋯ The incidence of severe pain, however, was more frequent in the propofol group. The small number of patients experiencing severe pain precluded statistical analysis. Blunting pain associated with propofol warrants further study.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of 4 analgesic agents for venipuncture.
This study compared pain on application, pain on venipuncture, cost, and convenience of 4 analgesic agents used for venipuncture. A convenience sample of 280 preoperative subjects was assigned randomly to 1 of 4 groups. Group 1 received 2.5% lidocaine--2.5% prilocaine cream (LPC) topically, Group 2 received dichlorotetrafluoroethane spray (DCTF), Group 3 received 0.5% lidocaine subcutaneously, and group 4 received normal saline with 0.9% benzyl alcohol (BA) subcutaneously. ⋯ Lidocaine, DCTF, and BA were equally convenient to use, while LPC was the least convenient, (P < .05). Lidocaine had low pain on venipuncture and low cost and convenience of use, but it was less than ideal in terms of pain on application. The BA had all the qualities of an ideal analgesic agent for venipuncture in this sample and should be considered as an analgesic agent for venipuncture.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of Whitacre spinal needle orifice direction on the level of sensory blockade.
The purposes of the present study were to determine if the direction of the needle orifice during injection of anesthetic into the subarachnoid space, using a 25-gauge Whitacre spinal needle (Becton Dickinson, Franklin Lakes, NJ) to deliver 15 mg of 0.75% hyperbaric bupivacaine, affected the level of sensory blockade achieved, and if there was a difference in time from injection to surgical anesthesia based on needle orifice direction. A convenience sample was selected from patients presenting for elective surgical procedures. All patients received a standard anesthetic solution using a standard technique and duration of injection. ⋯ An incidental finding was that all failed blocks were from the caudad group. There was no statistically significant difference in time from injection to surgical anesthesia between the treatment groups. Although the data support no statistically significant difference between the treatment groups for either research question, the cephalad group provides for a more precise height of block.