Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Clinical TrialThe analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery.
To assess the efficacy and safety of wound instillation of ropivacaine, when administered via a patient-controlled elastometric pump, 50 term parturients undergoing cesarean delivery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard spinal anesthetic was administered. After the surgery, a multihole 20-gauge epidural catheter (B. ⋯ However, blood ropivacaine accumulation was noted. All patients stated that the elastometric pump was easy to use. Ropivacaine wound instillation via an elastometric pump is a simple technique that provides safe and effective analgesia after cesarean delivery.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Clinical TrialThe use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery.
We evaluated the effect of 25 microg of fentanyl added to bupivacaine on sensory and motor block. By using a double-blinded study design, 80 men undergoing urologic surgery were randomized into the following four groups: Group I, bupivacaine 10 mg; Group II, bupivacaine 10 mg + fentanyl 25 microg; Group III, bupivacaine 7.5 mg + fentanyl 25 microg; Group IV, bupivacaine 5 mg + fentanyl 25 microg. The final volume of intrathecal injectate was adjusted to 2. 5 mL with sterile distilled water. ⋯ The addition of 25 microg of fentanyl to 5 mg of bupivacaine resulted in short-acting motor block. When 25 microg of fentanyl was added to 10 mg of bupivacaine, it increased the intensity and duration of motor block. Only 5 (6. 3%) of the patients needed supplemental analgesia during the operation. ¿abs¿
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Clinical TrialThe efficacy of intrathecal morphine and clonidine in the treatment of pain after spinal cord injury.
We performed a double-blinded, randomized, controlled trial in 15 patients to determine the efficacy of intrathecal morphine or clonidine, alone or combined, in the treatment of neuropathic pain after spinal cord injury. The combination of morphine and clonidine produced significantly more pain relief than placebo 4 h after administration; either morphine or clonidine alone did not produce as much pain relief. In addition, lumbar and cervical cerebrospinal fluid (CSF) concentrations, sampled at these levels at different times after administration were examined for a relationship between pain relief and CSF drug concentration. ⋯ The concentration of morphine in the cervical CSF and the degree of pain relief correlated significantly. We conclude that intrathecal administration of a mixture of clonidine and morphine is more effective than either drug administered alone and is related to the CSF-borne drug concentration above the level of spinal cord injury. If there is pathology that may restrict CSF flow, consideration should be given to intrathecal administration above the level of spinal cord damage to provide an adequate drug concentration in this region.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery.
The unique pharmacokinetic properties of remifentanil make it a potentially useful adjuvant during general anesthesia for ambulatory surgery. Fentanyl, inexpensive and easy to administer, is the most common opioid used for this purpose. As an adjuvant to general anesthesia for outpatient gynecologic surgery, we questioned if remifentanil was cost-effective as an alternative to fentanyl. ⋯ The incidence of rescue antiemetic treatment (2 of 16 vs. 8 of 18; P = 0.013) and the nausea visual analog scale scores during second stage recovery (0.2 vs. 0.6; P = 0.044) were more frequent in the study group. However, the incidence of intraoperative adverse events and other postoperative sequelae, recovery times, pain and nausea visual analog scale scores, opioid analgesic dosage requirements in the postanesthetic care unit, and satisfaction survey responses were similar between groups. Perioperative drug costs per patient were $17.72 more in the remifentanil (vs. fentanyl) group.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialThe use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study.
We sought to determine the minimum effective dose of dexamethasone in preventing postoperative nausea and vomiting in women undergoing thyroidectomy. Two hundred twenty-five women (n = 45 in each of five groups) undergoing thyroidectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. Immediately after the induction of anesthesia, patients received IV dexamethasone at doses of 10 mg (D10), 5 mg (D5), 2.5 mg (D2.5), 1.25 mg (D1.25), or saline (S). ⋯ Dexamethasone 2.5 mg reduced the total incidence of nausea and vomiting. Dexamethasone 1.25 mg was not effective. Dexamethasone 5 mg IV is the minimum effective dose in preventing postoperative nausea and vomiting in women undergoing thyroidectomy.