Articles: postoperative-pain.
-
Acta Anaesthesiol Scand · Oct 1989
Randomized Controlled Trial Comparative Study Clinical TrialEffects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy.
Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml/h + 0.2 mg/h, respectively for 8 h postoperatively. Mean initial spread of sensory analgesia on the right side was the same (Th3,4-Th11 versus Th2,6-Th11), but decreased (P less than 0.05) postoperatively in the paravertebral group. All patients in the epidural group had bilateral blockade, compared with three patients in the paravertebral group. ⋯ Pulmonary function estimated by forced vital capacity, forced expiratory volume and peak expiratory flow rate decreased about 50% postoperatively in both groups. In conclusion, the continuous paravertebral bupivacaine infusion used here was insufficient as the only analgesic after cholecystectomy. In contrast, epidural blockade with combined bupivacaine and low dose morphine produced total pain relief in six of ten patients.
-
Acta Anaesthesiol Scand · Oct 1989
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the effects of continuous intrapleural vs epidural administration of 0.5% bupivacaine on pain, metabolic response and pulmonary function following cholecystectomy.
Twenty patients undergoing elective cholecystectomy were prospectively randomised to receive either intrapleural (bolus 20 ml followed by 10 ml/h) or thoracic epidural (bolus 9 ml followed by 5 ml/h) bupivacaine 0.5% for 8 h postoperatively to assess the effect of these two techniques on pain, pulmonary function and the surgical stress response. As assessed by the visual analogue scale (VAS), both groups received good but not total pain relief. Both groups had a 50% reduction in forced expiratory volume (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) after operation, and there was no observed effect on the stress response as measured by plasma glucose and cortisol. It is concluded that while both techniques provide good analgesia, the degree and extent of nerve blockade are not sufficient to affect the afferent neurogenic stimuli responsible for the observed effects on pulmonary function and the stress response.
-
Minerva anestesiologica · Oct 1989
Comparative Study[Anesthesia for shoulder surgery. Comparison of anesthesiologic problems and technics].
We evaluated the ability of general, regional (interscalene block) and balanced anaesthesia (interscalene block supplemented by general anaesthesia) to manage the problems of shoulder surgery. Our results show that general anaesthesia is not adequate. ⋯ The positions of patient and surgeons cause the main disadvantages of anaesthesia with interscalene block alone, ad the control of airway of sedated patients is difficult and performing general anaesthesia in case of insufficient analgesia may be troublesome. Balanced anaesthesia, as compared to regional block alone, allows a safer control of respiration and an easier control of surgical analgesia.
-
Thorac Cardiovasc Surg · Oct 1989
Repetitive intercostal nerve block via catheter for postoperative pain relief after thoracotomy.
After anterolateral thoracotomy, before incision closure, indwelling plastic catheters were inserted percutaneously under digital and/or visual control into the intercostal space of access and the two neighbouring ones. Initially, we injected 25 mg of bupivacaine through each catheter (to a total of 75 mg), and subsequently - on the patients demand - another 15 to 25 mg per catheter. To date, 25 patients received repetitive intercostal nerve blocks by this method (ICB-group). ⋯ SA: 13%) were observed less frequently than in the control group, whereas tachyarrhythmia occurred in 6 of 25 ICB-patients compared to 4 of 30 SA-patients. Nevertheless, none of these parameters reached statistical significance (p less than 0.05). Maximum bupivacaine levels of 0.65 +/- 0.21 micrograms/ml were found after 29 +/- 12 min of intercostal application.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Randomized Controlled Trial Clinical Trial
Postoperative analgesia with extradural clonidine.
The analgesic effect of extradural clonidine was evaluated in a double-blind study. In the recovery room, following orthopaedic or perineal surgery 20 ASA I and II patients were allocated randomly to two groups. The extradural clonidine (EC) group received clonidine 2 micrograms kg-1 in isotonic saline solution 15 micrograms ml-1. ⋯ In the EC group, the mean (SD) maximum pain relief was 68.2 (24.1)% of the initial VAS score, but it was only 14.7 (25.2)% in the ES group. The mean duration of analgesia, before injection of morphine, was significantly longer in the EC group (210 (87) min) compared with the ES group (45 (27) min) (P less than 0.001). Drowsiness and moderate hypotension were observed in the EC group.