Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialSequential combined spinal epidural block versus spinal block for cesarean section: effects on maternal hypotension and neurobehavioral function of the newborn.
Sequential combined spinal-epidural (CSE) block was compared with spinal block for elective cesarean section. The quality of surgical analgesia and the effect on maternal blood pressure and neonatal neurobehavioral function were evaluated. Forty-two healthy parturients were randomly divided into a spinal (n = 21) and a sequential CSE (n = 21) group. ⋯ Cephalad spread of block (pinprick) 15 min after induction was T4 [T2-T7] (median [range]) in the spinal group and T7 [T2-L1] in the sequential CSE group (P < 0.05). All patients in the sequential CSE group needed epidural bupivacaine, 53.8 +/- 6.5 mg (mean +/- SEM). The surgical analgesia was good or excellent in both groups before delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialEpidural-morphine-induced pruritus: propofol versus naloxone.
In a prospective, randomized, double-blind clinical trial, we compared the efficacy of propofol and naloxone for the treatment of spinal-morphine-induced pruritus. Forty patients presenting with severe pruritus within 24 h of epidural morphine administration were allocated to receive either propofol 10 mg intravenously (i.v.) or naloxone 2 micrograms/kg. In the absence of a positive response, a second dose of the same treatment was given 5 min later. ⋯ Forty-five percent of the patients in the naloxone group had an increase in the level of postoperative pain versus none in the propofol group (P < 0.05). In conclusion, these results suggest that propofol and naloxone are equally effective in treating spinal-morphine-induced pruritus. However, the level of postoperative pain is significantly less in the propofol group.
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Anesthesia and analgesia · Jun 1994
Randomized Controlled Trial Clinical TrialEpidural butorphanol does not reduce side effects from epidural morphine after cesarean birth.
In this prospective, double-blind, randomized study of women undergoing elective cesarean birth, the hypothesis that epidural butorphanol in various doses could effectively reduce or eliminate the side effects caused by epidural morphine was tested. Patients were randomly assigned to one of four groups. All received a standard epidural anesthetic and 20 min after delivery each received 3 mg epidural morphine with either 1 mg butorphanol (Group A), 2 mg butorphanol (Group B), 3 mg butorphanol (Group C), or 3 mL normal saline (Group D). ⋯ There were no clinically significant incidents of respiratory depression. Epidural butorphanol, in doses of 1-3 mg, failed to reduce the side effects from 3 mg epidural morphine given after cesarean birth. Patients who received epidural butorphanol reported significantly higher levels of somnolence.
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Anesthesia and analgesia · Jun 1994
Randomized Controlled Trial Clinical TrialSpinal anesthesia with ropivacaine: a double-blind study on the efficacy and safety of 0.5% and 0.75% solutions in patients undergoing minor lower limb surgery.
The purpose of this study was to determine the clinical efficacy and safety of ropivacaine as a local anesthetic for spinal anesthesia. Forty patients between the ages of 18 and 75 yr, scheduled for minor lower limb surgery, were studied. They were randomly allocated to receive either 3 mL glucose-free 0.5% (15 mg) or 0.75% (22.5 mg) ropivacaine in a double-blind fashion. ⋯ The incidence of complete motor block of the lower limbs was higher (P < 0.02) and the total duration of motor block longer (P < 0.002) in the 0.75% group. No unexpected adverse events were registered. We conclude that subarachnoid injection of glucose-free ropivacaine solutions results in a variable spread of analgesia, mostly accompanied by a good quality of motor block, in particular with the 0.75% solution.
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Anesthesia and analgesia · Jun 1994
Randomized Controlled Trial Comparative Study Clinical TrialEpidural versus subcutaneous administration of alfentanil for the management of postoperative pain.
This study was designed to compare the efficacy and serum concentrations of alfentanil given subcutaneously (SQ) or epidurally (EPID) for treatment of postoperative pain. Following abdominal surgery, patients (n = 12) were randomly assigned to receive double-blind SQ or EPID alfentanil over 24 h via the allocated route (1 mg along with 0.2 mg/h and 0.2-mg boluses on demand) and saline via the other route of administration using a patient-controlled analgesic (PCA) delivery system. Significantly less EPID alfentanil produced better quality analgesia and fewer side effects than SQ alfentanil. The fact that EPID analgesia was maintained with serum alfentanil concentrations less than those producing systemic analgesia confirms the spinal site of the EPID alfentanil action.