Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 1999
Randomized Controlled Trial Clinical TrialSpinal clonidine prolongs labor analgesia from spinal sufentanil and bupivacaine.
We sought to determine whether spinal clonidine 50 microg prolongs the analgesia from the spinal administration of sufentanil 7.5 microg and bupivacaine 2.5 mg early in the first stage of labor. Thirty patients were randomized to receive a 2-mL spinal injection of sufentanil 7.5 microg + bupivacaine 2.5 mg with or without clonidine 50 microg using a combined spinal-epidural (CSE) technique. Pain, nausea, pruritus, sedation, motor block, blood pressure, and heart rate were assessed until the patient requested additional analgesia. Analgesia was significantly prolonged in patients who received spinal sufentanil + bupivacaine + clonidine (197 +/- 70 vs 132 +/- 39 min; P = 0.004). Pain scores and side effects, including motor block, sedation, and hypotension, were similar between groups. Spinal clonidine significantly prolongs labor analgesia from spinal sufentanil and bupivacaine without producing serious adverse side effects. ⋯ We studied the effects of spinal clonidine administered with spinal sufentanil and bupivacaine on labor analgesia using a combined spinal-epidural technique and conclude that spinal clonidine significantly prolongs labor analgesia from spinal sufentanil and bupivacaine without producing serious adverse effects.
-
Anesthesia and analgesia · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison among nalbuphine, meperidine, and placebo for treating postanesthetic shivering.
Postanesthetic shivering (PS) is distressing for patients and may induce a variety of complications. In this prospective, double-blinded, randomized study, we evaluated the value of nalbuphine, compared with meperidine and saline, for treating PS. Ninety adult patients were included in the study. Group 1 (n = 30) received i.v. nalbuphine 0.08 mg/kg, Group 2 (n = 30) received i.v. meperidine 0.4 mg/kg, and Group 3 (n = 30) received i.v. saline. Treatment that stopped shivering was considered to have been successful. The results demonstrated that, 5 min after treatment, both nalbuphine and meperidine provided a rapid and potent anti-shivering effect on PS, with high response rates of 80% and 83%, compared with those of saline (0%) (P < 0.01). Thirty minutes after injection, the response rates of nalbuphine and meperidine were 90% and 93%, respectively, compared with 17% in the saline group (P < 0.01). The differences between nalbuphine and meperidine were not significant. We conclude that nalbuphine may be an alternative to meperidine for treating PS. ⋯ We evaluated nalbuphine versus meperidine and saline for treating postanesthetic shivering. Our results demonstrate that both nalbuphine and meperidine provide a similar rapid and potent anti-shivering effect. Nalbuphine may be an alternative to meperidine for treating postanesthetic shivering.
-
Anesthesia and analgesia · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialPulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaine.
The purpose of this investigation was to compare, in a prospective, double-blinded fashion, 0.5% and 0.75% ropivacaine with 2% mepivacaine to determine their effects on respiratory function during interscalene brachial plexus (IBP) anesthesia. With ethical committee approval and written, informed consent, 30 healthy patients presenting for elective shoulder capsuloplastic or acromioplastic procedures were randomized to receive IBP anesthesia by 20 mL of either 0.5% ropivacaine (n = 10), 0.75% ropivacaine (n = 10), or 2% mepivacaine (n = 10). Block onset time, pulmonary function variables, ipsilateral hemidiaphragmatic motion (ultrasonographic evaluation), and first requirement of postoperative analgesic were evaluated. Surgical anesthesia (loss of pinprick sensation from C4 to C7 and motor block of the shoulder joint) was achieved later with 0.5% ropivacaine than with either 0.75% ropivacaine or 2% mepivacaine (P < 0.05), whereas the first pain medication was requested later with both ropivacaine concentrations than with mepivacaine (P < 0.0005). No differences in quality of the block or patient acceptance were observed in the three groups. All 30 patients had ipsilateral hemidiaphragmatic paresis and large mean decreases in forced vital capacity (ropivacaine 0.5%: 40% +/- 17%, ropivacaine 0.75%: 41% +/- 22%, mepivacaine 2%: 39% +/- 21%) and forced expiratory volume at 1 s (ropivacaine 0.5%: 30% +/- 19%, ropivacaine 0.75%: 38% +/- 26%, mepivacaine 2%: 40% +/- 10%). We conclude that, when performing IBP anesthesia, 0.5% ropivacaine does not decrease the incidence of ipsilateral paresis of the hemidiaphragm compared with 0.75% ropivacaine and 2% mepivacaine. ⋯ During the first 30 min after placing interscalene brachial plexus anesthesia, 0.5% ropivacaine does not provide clinically relevant advantages in terms of pulmonary function changes compared with either 0.75% ropivacaine or 2% mepivacaine. However, 0.75% ropivacaine allows a short onset, similar to that of mepivacaine, with long postoperative analgesia.
-
Anesthesia and analgesia · Mar 1999
Randomized Controlled Trial Multicenter Study Clinical TrialA double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery.
We assessed the relative morphine consumption in a combined analgesic regimen (on-demand morphine plus the nonopioids propacetamol or ketorolac) after gynecologic surgery. Two hundred women randomly received two i.v. doses of propacetamol 2 g or ketorolac 30 mg in a double-blinded, double-dummy trial. Patients were monitored for 12 h, and the following efficacy variables were assessed: total dose of morphine, pain intensity, and global efficacy. Safety and tolerability were evaluated by the occurrence of adverse events, especially the presence and intensity of gastrointestinal symptoms. Hemostatic variables were measured 30 and 60 min after the first infusion; arterial blood pressure, heart and respiratory rates, sedation scores, and renal and hepatic function were also assessed. Total morphine requirements were not significantly different between the propacetamol (10.6 +/- 4.8 mg) and ketorolac (10.2 +/- 4.4 mg) groups. The evolution of pain intensity and the global efficacy also showed similar patterns in the two groups: 70.2% of patients in the propacetamol group rated the efficacy as "good/ excellent" compared with 68.2% in the ketorolac group. There were no clinically significant changes in vital signs or laboratory values and no observed differences between the two groups, although ketorolac slightly, but not significantly, prolonged the bleeding time. Epigastric pain was present in 9% and 15% of patients receiving propacetamol and ketorolac, respectively. There were two adverse events in the propacetamol group and four in the ketorolac group. Propacetamol demonstrates an efficacy similar to that of ketorolac and has an excellent tolerability after gynecologic surgery. ⋯ Propacetamol and ketorolac, combined with patient-controlled analgesia morphine, show similar analgesic efficacy after gynecologic surgery. Morphine consumption and pain scores were comparable in the two studied groups. Propacetamol is as effective as ketorolac and has an excellent tolerability after gynecologic surgery.
-
Anesthesia and analgesia · Mar 1999
Randomized Controlled Trial Clinical TrialAdenosine reduces secondary hyperalgesia in two human models of cutaneous inflammatory pain.
Secondary hyperalgesia is characterized by increased sensitivity to noxious mechanical stimuli in the area surrounding injured skin. The pathophysiological mechanisms involve increased excitability of second-order neurons located in the spinal cord, i.e., central sensitization. The mechanisms behind this phenomenon may be of importance in clinical pain, including neuropathic pain. To study the effects of systemic infusion of the endogenous compound adenosine (ADO) on sensory function, a superficial cutaneous burn injury was induced by the 4-min topical application of mustard oil or by heat (47 degrees C for 7 min) during i.v. ADO infusion (60 microg x kg(-1) x min(-1)). Healthy human subjects (n = 10 for each model) were tested, using a blinded, placebo-controlled procedure. The area of secondary hyperalgesia, as well as tactile and thermal sensory function, was tested using psychophysical methods during and after treatments. ADO significantly reduced the area of secondary hyperalgesia in both models. The maximal reduction compared with placebo was 58% +/- 20% (heat burn) and 39% +/- 13% (mustard oil burn). No other differences in sensory function were observed. The results are interpreted as an ADO-induced modulatory effect on the mechanisms of central sensitization. ⋯ We tested the effects of adenosine on the development of increased sensitivity in the skin surrounding a superficial skin injury in humans. A superficial skin bum was induced with a chemical irritant or heat. The results show that adenosine reduces the skin area with increased sensitivity surrounding the injury.