CRNA : the clinical forum for nurse anesthetists
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Randomized Controlled Trial Clinical Trial
Effects of tourniquet time in knee arthroscopy patients receiving intraarticular morphine combined with bupivacaine.
The purpose of the study was to compare the duration of analgesia and the amount of supplemental postoperative analgesics required when morphine combined with bupivacaine was injected into the knee joint at the end of knee arthroscopy surgery. Varying tourniquet times of 0, 8, or 16 minutes were used after the injection. The variables examined were the duration of analgesia, and the amount of supplemental postoperative analgesics required in each subgroup. ⋯ No statistical differences were found between groups. All patients received analgesia with no reported side effects. Increasing the tourniquet time had no effect on the duration of analgesia or the amount of supplemental narcotics required in the postoperative period.
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Preemptive analgesia describes a situation where the administration of a pharmacological agent administered before the onset of a painful stimulus causes a decrease in the intensity of pain felt, and subsequently there is a decrease in the total amount of analgesic required compared with the administration of an agent after a painful stimulus. It is best understood if it is thought of as a block to afferent impulses that are trying to reach the central nervous system before a tissue injury. Preemptive analgesia, administered in the form of narcotics, nonsteroidal antiinflammatory agents, or local anesthetics, is thought to alter peripheral and central sensitization to nociceptive impulses.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intraoperative morphine sulfate and methadone hydrochloride on postoperative visual analogue scale pain scores and narcotic requirements.
Morphine sulfate and methadone hydrochloride exhibit very different half-lives but are described as having an analgesic potency of one. The use of a drug like methadone may provide prolonged and constant analgesia in the perioperative setting. This double-blinded investigation used methadone and morphine intraoperatively and measured pain scores and narcotic requirements in the first 24 hours postoperatively. ⋯ Fifteen patients received morphine and fifteen patients received methadone. There was no significant difference between the two groups in terms of age, height, weight, and ASA status. No statistically significant difference was observed among the two groups between the amount of analgesic requirements postoperatively or in the visual analogue scale pain score.
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Randomized Controlled Trial Clinical Trial
Comparison of sufentanil versus fentanyl with 0.125% bupivacaine for continuous labor epidural anesthesia.
The search for an ideal combination of agents for labor epidural anesthesia has become a focus of current research studies. This study was performed to determine if a combination of sufentanil with bupivacaine would show superior analgesia and fewer side effects when compared with an equipotent combination of fentanyl with bupivacaine in continuous labor epidurals. After the approval of the Human Investigations Committee and written consent from the subjects, 54 parturients were assigned to receive one of two epidural drug combinations in a randomized double-blind design. ⋯ There were no statistically significant differences found in VAS scores or requirement for epidural top-up injections between the two groups. Demographics, side effects, apgar scores, and maternal satisfaction scores were also comparable. Both sufentanil and fentanyl with bupivacaine provide comparably safe and satisfactory analgesia for labor epidural anesthesia.
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Pipecuronium Bromide (Arduan, Organon, Inc, West Orange) is a long-acting, nondepolarizing neuromuscular blocking agent. The efficacy of pyridostigmine 170 micrograms/kg intravenously (approximately 10 mg/70 kg) for reversing pipecuronium has not been reported. This study was performed to determine the time required to obtain a train-of-four (TOF) ratio of 0.7 after administration of pyridostigmine 140 micrograms/kg at 25% recovery of T1 after pipecuronium-induced neuromuscular blockade. ⋯ Anesthesia was maintained with a nitrous oxide/narcotic technique and the use of potent inhalational anesthetics was avoided. The mean reversal time was found to be 16.14 minutes, with a minimum of 10.3 minutes and a maximum of 24.3 minutes. The standard error was +/- 1.05 minutes with a variance of 17.68 minutes.