Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Comparative Study Clinical TrialContinuous infraclavicular perineural infusion with clonidine and ropivacaine compared with ropivacaine alone: a randomized, double-blinded, controlled study.
Although clonidine has been shown to increase the duration of local anesthetic action and prolong postoperative analgesia when included in single-injection nerve blocks, a controlled investigation of the efficacy of this practice to improve analgesia for continuous perineural local anesthetic infusion has not been reported. In this study, ambulatory patients (n = 34) undergoing moderately painful upper extremity orthopedic surgery received an infraclavicular brachial plexus block (mepivacaine 1.5%, epinephrine 2.5 micro g/mL, and bicarbonate 0.1 mEq/mL) and a perineural catheter before surgery. After surgery, patients were discharged home with a portable infusion pump delivering either ropivacaine 0.2% or ropivacaine 0.2% plus clonidine 1 micro g/mL via the catheter for 3 days (basal, 8 mL/h; patient-controlled bolus, 2 mL every 20 min). ⋯ Adding clonidine to ropivacaine resulted in a statistically significant decrease in the number of self-administered 2-mL bolus doses on postoperative Days 0 and 1 (P < 0.02), but this decreased actual local anesthetic consumption by an average of only 2-7 mL/d (P < 0.02). There were no statistically significant differences between the two groups for any of the other variables investigated, including sleep quality or oral analgesic requirements. We conclude that adding 1 micro g/mL of clonidine to a ropivacaine infraclavicular perineural infusion does not provide clinically relevant improvements in analgesia, sleep quality, or oral analgesic requirements for ambulatory patients having moderately painful upper extremity surgery.
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialThe effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery.
In a randomized, double-blinded study, we evaluated the analgesic effect of ketamine in the management of pain in a surgical intensive care unit after major abdominal surgery. Patients received morphine patient-controlled analgesia with either placebo (Group M) or ketamine (Group K). Morphine was administered with initial loading doses of 2 mg until the visual analog scale (VAS) score was <30 and thereafter with bolus doses of 1 mg and a lockout time of 7 min. ⋯ VAS scores at rest and at mobilization were similar. The cumulative consumption of morphine was significantly smaller in Group K (P < 0.05). We concluded that small doses of ketamine were a valuable adjunct to opioids in surgical intensive care unit patients after major abdominal surgery.
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialAwake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil.
Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. ⋯ Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialThe efficacy of 5% lidocaine-prilocaine (EMLA) cream on pain during intravenous injection of propofol.
Topical anesthesia using 60% lidocaine tape reduces the incidence of propofol injection pain. We conducted a randomized prospective double-blinded placebo-controlled study to assess the analgesic efficacy of pretreatment with topical 5% lidocaine-prilocaine (EMLA) cream in 90 ASA physical status I and II adult patients scheduled to undergo day-case gynecological surgery. Propofol injection pain was not reduced by pretreatment with EMLA cream, whereas the addition of lidocaine to propofol did significantly reduce propofol injection pain compared with the control group (P = 0.002). We conclude that topical anesthesia with EMLA cream applied for 60 min does not significantly reduce propofol injection pain.
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Anesthesia and analgesia · Sep 2003
Clinical TrialPerioperative continuous peripheral nerve blocks with disposable infusion pumps in children: a prospective descriptive study.
Continuous peripheral nerve blocks (CPNB) after pediatric major orthopedic surgery are not widely used. We conducted a prospective descriptive study to evaluate the effectiveness of disposable elastomeric pumps for CPNB in children. After inducing general anesthesia, 25 consecutive children scheduled for major orthopedic surgery received a 0.5-mL/kg bolus of a mixture of 1% lidocaine with epinephrine and 0.25% bupivacaine in axillary, femoral, or popliteal catheters. ⋯ Sensory and motor block were noted at H1 and decreased from the sixth hour. No adverse events were noted. We concluded that the use of elastomeric disposable pumps for CPNB in children was an effective technique.