Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine.
The purpose of this study was to compare meperidine to meperidine with bupivacaine when used for patient-controlled epidural analgesia (PCEA) after thoracotomy. For 3 days after thoracotomy patients received thoracic PCEA with meperidine 0.1% plain or with added bupivacaine 0.1% or 0.01%. No background infusion was used. ⋯ The addition of bupivacaine 0.1% reduced the incidence of pruritus (P = 0.036), but 5 of 23 patients in this group were with-drawn from the study because of significant hypotension, oliguria, and/or motor or sensory block (P = 0.006). We conclude that the addition of bupivacaine 0.1% or 0.01% to thoracic PCEA meperidine 0.1% does not affect meperidine requirements or analgesia after thoracotomy. The addition of bupivacaine 0.1% may reduce pruritus, but is associated with signs of excessive sensory, motor, or autonomic blockade in a significant number of patients.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous tramadol versus epidural morphine for postthoracotomy pain relief: a placebo-controlled double-blind trial.
Tramadol, an analgesic deriving only part of its effect via opioid agonist activity, might provide postoperative pain relief with minimal risk of respiratory depression. We, therefore, evaluated it for the control of postthoracotomy pain. In this randomized, double-blind study, a single intravenous (IV) bolus dose of 150 mg tramadol (Group T) was compared to epidural morphine administered as an initial 2-mg bolus and subsequent continuous infusion at a rate of 0.2 mg/h (Group M). ⋯ Pao2 was significantly higher in Group T at 2 h and Paco2 significantly higher in Group M at 4 h postoperatively. There were no other significant respiratory differences. We conclude that a single dose of 150 mg tramadol given at the end of surgery provided postoperative analgesia equivalent to that provided by this dosage regimen of epidural morphine for the initial postoperative period.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialCombination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting.
The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. ⋯ A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialSustained-release ibuprofen as an adjunct to morphine patient-controlled analgesia.
Previous studies have demonstrated reduced postoperative morphine requirements and/or improved pain relief when nonsteroidal antiinflammatory drugs are administered in conjunction with patient-controlled analgesia (PCA). This double-blind study aimed to determine whether these effects could be obtained with a sustained-release ibuprofen formulation (Brufen Retard) given preoperatively, obviating the need for oral administration during the early postoperative period. We aimed also to determine whether the anticipated reduction in morphine requirements was associated with reduced opioid side effects. ⋯ Morphine consumption was slightly but not significantly lower in the ibuprofen group (32 vs 38 mg/24 h, P = 0.096). Spo2 (P = 0.54), level of consciousness (P = 0.65), and number of antiemetic administrations (P = 0.15) did not differ significantly between groups. These results demonstrate improved efficacy with no increase in side effects when sustained-release ibuprofen is used as an adjunct to morphine PCA.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialTranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery.
The administration of tranexamic acid (TA) prior to cardiopulmonary bypass (CPB) has been associated with reduced bleeding during and after cardiac surgery. In a prospective, randomized, controlled, double-blind clinical trial, adult patients undergoing repeat open heart surgery received TA (n = 17) or an equal volume of saline placebo (n = 13). In the TA group, a 20-mg/kg intravenous (IV) initial dose of TA at akin incision was followed by an infusion of 2 mg.kg-1.h-1, which continued for the duration of the surgical procedure. ⋯ Sternal closure occurred in 41 +/- 21 min in the TA group and 61 +/- 49 min in the placebo group (P = 0.14), and the subjective bleeding score was less in the TA group than in the placebo group (2.38 +/- 0.78 vs 3.08 +/- 1.04; P = 0.045). The data from the current study support the prophylactic use of TA in patients undergoing repeat cardiac surgery. TA administered prior to CPB reduced the incidence of allogeneic transfusions and postoperative mediastinal tube drainage, and improved the subjective assessment of post-CPB hemostasis in a group of patients at moderately high risk for perioperative bleeding.