Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous regional anesthesia using lidocaine and ketorolac.
Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. ⋯ Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of N-methyl-D-aspartate antagonist (ketamine) on single and repeated nociceptive stimuli: a placebo-controlled experimental human study.
Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor channel blocker known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. We sought to assess the effect of ketamine on single and repeated nociceptive stimuli. A placebo-controlled, human (12 volunteers) experimental study was conducted in which several psychophysical (pain detection and tolerance thresholds, magnitude ratings) and electrophysiologic (withdrawal reflex) techniques were used 1) to investigate whether a ketamine (0.5 mg/kg) bolus followed by a 20-min infusion (9 micrograms.kg-1.min-1) inhibits central temporal summation to repeated nociceptive electrical stimuli, and 2) to assess quantitatively the hypoalgesic potency using several experimental nociceptive stimuli (argon laser, pressure, electrical). ⋯ The pressure pain detection and tolerance thresholds were increased significantly by ketamine, whereas the laser heat pain and tolerance thresholds remained stable compared with placebo. The stimulus response function showed that ketamine reduced the responses to the highest electrical stimulus intensities (1.4, 1.6, and 1.8 times the reflex threshold). We conclude that ketamine inhibits central temporal summation in humans and has a marked hypoalgesic effect on high intensity nociceptive stimuli.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialUse of sevoflurane during elective cesarean birth: a comparison with isoflurane and spinal anesthesia.
This randomized study compared sevoflurane 1% and isoflurane 0.5% in terms of maternal and neonatal outcomes. In addition, neonatal outcome in both groups was compared with a cohort of patients delivered by cesarean birth using spinal anesthesia. Fifty-five patients presenting for elective cesarean birth under general anesthesia were randomly assigned to receive either sevoflurane 1% or isoflurane 0.5% in a 50% nitrous oxide and oxygen mixture for maintenance. ⋯ Similarly, the level of postoperative comfort was the same in both groups. Comparing the general and the spinal anesthetic groups, no differences could be detected in neonatal outcome. Fluoride concentrations were modestly increased above preoperative levels in maternal and umbilical blood samples after sevoflurane administration.(ABSTRACT TRUNCATED AT 250 WORDS)