Southern medical journal
-
Southern medical journal · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of oral ketorolac, intramuscular morphine, and placebo for treatment of pain after orthopedic surgery.
Using a randomized, double-blind, placebo-controlled, parallel, single-dose, single-center, 6-hour study, we compared the analgesic response and tolerability of oral ketorolac tromethamine and intramuscular morphine sulfate and placebo. The study group comprised 176 patients with moderate, severe, or very severe pain after hip or knee surgery at a teaching hospital. Patients received either 10 mg of ketorolac orally, 10 mg of morphine intramuscularly, 5 mg of morphine IM, or placebo. ⋯ The 10-mg dose of morphine showed a small advantage over ketorolac in peak analgesic effect, but the onset of pain relief was comparable among the active agents. The incidence of adverse events among the active-treatment groups was similar, though there was a numerical trend favoring ketorolac over 10 mg of morphine. We found oral ketorolac to be an effective alternative to parenteral opioids for the treatment of pain after hip or knee surgery in patients who can tolerate oral medication.
-
To determine the accuracy of four pulse oximeters during mild and moderate arterial hypoxemia, we produced stepwise arterial blood desaturation in 25 healthy, nonsmoking volunteers by adjusting the inhaled oxygen concentration. At plateaus of < 80%, 85% to 90%, 90% to 95%, and 95% to 100%, pulse oximetry saturation (SpO2) was measured with the four different monitors: Dinamap Plus Model 8700, Oxyshuttle, Ohmeda 3700, and MiniOx IV. Arterial blood samples were analyzed with a co-oximeter and the arterial oxyhemoglobin saturation (SaO2) was compared with the SpO2 readings at each plateau. ⋯ In 14 instances of hypoxemia (SaO2 < 90%), subjects exhibited SpO2 values greater than 90%. In conclusion, the accuracy of pulse oximetry deteriorates as hypoxemia worsens. Confirmation of arterial blood oxyhemoglobin saturation by co-oximetry is necessary when precise determination of arterial oxyhemoglobin level is critical.
-
Southern medical journal · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia after major shoulder surgery with interscalene brachial plexus blockade: etidocaine versus bupivacaine.
Postoperative pain is commonly treated with significant doses of narcotics, occasionally resulting in side effects including nausea, pruritus, and respiratory depression. One potential advantage of regional anesthesia is profound postoperative analgesia that reduces exposure to potent narcotics. To evaluate the efficacy of two long-acting local anesthetics, bupivacaine and etidocaine, in providing pain relief after major shoulder surgery, we randomized 20 patients to receive either bupivacaine or etidocaine for brachial plexus block as the primary anesthetic for shoulder surgery. ⋯ Bupivacaine, however, possesses significant cardiotoxicity and has a relatively delayed onset in peripheral neural blockade. Etidocaine is less cardiotoxic and also has a more rapid onset of effect. Thus etidocaine may be a preferable agent for interscalene block for major shoulder surgery.
-
Southern medical journal · Apr 1994
Randomized Controlled Trial Multicenter Study Clinical TrialRandomized study of cefotaxime versus ceftriaxone for uncomplicated gonorrhea.
Cefotaxime is a third-generation cephalosporin with excellent in vitro antimicrobial activity against Neisseria gonorrhoeae, including beta-lactamase-producing strains. A single 1-g intramuscular dose is suitable for the treatment of uncomplicated gonorrhea. We conducted an open, randomized study to evaluate the efficacy, safety, and cost impact of a lower dose (500 mg) of cefotaxime versus 250 mg ceftriaxone, an often recommended treatment for uncomplicated gonorrhea. ⋯ Adverse clinical events occurred in 4% and 9% of patients in the two groups, respectively. The average wholesale price of 500 mg cefotaxime is 31% lower than that of 250 mg ceftriaxone. A 500-mg dose of cefotaxime appears to be a safe and cost-effective alternative to 250 mg ceftriaxone for the treatment of uncomplicated gonorrhea.
-
To determine the epidemiologic characteristics of hospital-acquired infections (HAI) in pediatric burn patients, we retrospectively reviewed hospital charts of pediatric burn patients from two similar burn units. All patients less than 18 years of age admitted to the burn unit from January 1, 1980 to July 10, 1988, were enrolled. Charts were analyzed for age, sex, burn injury (type, depth, burn surface area), and hospital course (burn wound therapy, use of indwelling catheters or tubes, infectious complications, antibiotic use, cause of death if patient died). ⋯ As in adult patients, burn wound infections, pulmonary infections, and catheter-associated bacteremias are the most common infections in burned children. However, urinary tract infections are more frequent in the pediatric population. Risk factors (> or = 20% full-thickness burns, indwelling devices) and causative organisms are similar in both age groups.