Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy.
Laparoscopy approach to cholecystectomy has shortened the recovery period, reducing discharge times from 1 to 3 days to same-day discharge. We hypothesize that the use of more than one modality to prevent postoperative pain may be more efficacious than single modality. Patients were randomized to a treatment (n = 24) or control (n = 25) group and studied using a prospective, double-blind design. ⋯ The incidence of nausea in the PACU was significantly less in the treatment group; 4.7% vs 29.5% in the control group (P < 0.05). Patients from the treatment group satisfied Postanesthesia Discharge Score significantly earlier than those in the control group (281 +/- 12 min vs 375 +/- 19 min; P < 005). The concomitant use of local anesthetic and nonsteroidal antiinflammatory and opioid drugs proved to be highly effective in our patients, resulting in faster recovery and discharge.
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Anesthesia and analgesia · Jan 1996
Comment Letter Randomized Controlled Trial Comparative Study Clinical TrialPropofol induction is more effective than ondansetron in prophylaxis of postoperative nausea, but not vomiting.
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Anesthesia and analgesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialIlioinguinal iliohypogastric nerve blocks--before or after cesarean delivery under spinal anesthesia?
Preoperative local anesthetic blockade of somatosensory pathways involved with skin incision and other noxious perioperative stimuli may "preempt" or attenuate the postoperative pain response. Since the Pfannenstiel incision lies within the L1 dermatome, bilateral ilioinguinal, iliohypogastric nerve blocks (IINBs) should provide analgesia after low transverse cesarean section. We designed this study to compare the analgesic effect of IINBs placed before or after cesarean delivery. ⋯ Patient satisfaction and morphine use did not differ among the groups. We conclude that there is no benefit to ilioinguinal nerve blocks, either before or after surgery, in patients who receive spinal anesthesia for elective cesarean delivery. Our finding of increased pain in the After group is perplexing and requires confirmation.
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Anesthesia and analgesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialOral transmucosal fentanyl citrate for premedication in adults.
This study was designed to assess the efficacy of oral transmucosal fentanyl citrate (OTFC) for premedication in an adult population and to determine its effects on anxiety, sedation, gastric volume, and gastric fluid acidity. The fentanyl citrate is incorporated in a lozenge mounted on a handle (oralet). The effects of OTFC, placebo oralet, and no premedication were compared in a prospective, double-blind study on 90 adult ASA physical status I and II patients undergoing same-day admission surgery. ⋯ This study demonstrates that the OTFC oralet is an effective anxiolytic in adults. It has minimal side effects and is prepared in an acceptable format. There was no measurable increase in gastric contents or acidity in the oralet groups, compared to those patients who were given nothing by mouth.
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Anesthesia and analgesia · Jan 1996
Randomized Controlled Trial Clinical TrialThe effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl.
The study was performed to determine whether epidural fentanyl produced segmental sensory changes to electrical stimulation at different frequencies. Eight healthy volunteers received fentanyl 1 microgram/kg both intravenously and epidurally in a randomized, double-blind, cross-over fashion. Perception thresholds and amount of current required to elicit a predetermined level of moderate pain (Cmp) at 5,250, and 2000 Hz stimulation were measured at ipsilateral dermatomes C2 and L2 at 0, 5, 15, 30, 45, and 60 min after injection. ⋯ In contrast, epidural fentanyl increased Cmp only at the L2 dermatome and only at 5 Hz (P = 0.005). We conclude that an epidural bolus of fentanyl results in segmental spinal analgesia to transcutaneous electrical stimulation only at specific frequencies. Furthermore, pain produced by stimulation at 5 Hz may have a different pharmacology than pain produced by 250 Hz stimulation.