European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Implications of the use of neuromuscular transmission monitoring on immediate postoperative extubation in off-pump coronary artery bypass surgery.
When continuous infusions of neuromuscular blocking drugs are administered during lengthy interventions and no routine antagonism of their effects is applied, there is a dramatic incidence of residual curarization. We have examined whether the use of neuromuscular transmission monitoring results in differences in the incidence of postoperative residual curarization, the use of antagonist agents, and the endotracheal extubation rate and outcome after continuous infusion of rocuronium in patients undergoing off-pump coronary artery bypass surgery. ⋯ Although we found no additional benefit of using neuromuscular transmission monitoring, it seems an absolute necessity for safety reasons. Pharmacological antagonism was mandatory. However, in our opinion, it is not wise routinely to perform immediate postoperative extubation in off-pump coronary artery bypass surgery.
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Randomized Controlled Trial Clinical Trial
Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy.
Intraperitoneal administration of a local anaesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported except after laparoscopic cholecystectomy. This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and morphine in patients undergoing laparoscopic cholecystectomy. ⋯ In patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of morphine plus bupivacaine 0.25% reduced the analgesic requirements during the first 6 postoperative hours compared with the control group. However, the combination of intraperitoneal bupivacaine 0.25% and i.v. morphine was more effective for treatment of pain after laparoscopic cholecystectomy.
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Randomized Controlled Trial Clinical Trial
Perioperative intravenous adenosine infusion to extend postoperative analgesia in brachial plexus block.
Adenosine infusions have been shown to reduce requirements of anaesthetics, to decrease the need for postoperative analgesics and to attenuate hyperaesthesia related to neuropathic pain. We decided to investigate the effects, beneficial or otherwise, of an adenosine infusion administered during surgery. A brachial plexus block was used to produce anaesthesia for the surgery. ⋯ In patients undergoing surgery with an axillary plexus block, a perioperative adenosine infusion prolongs the duration of postoperative analgesia to some extent. However, the time to first rescue analgesic, total analgesic requirements and pain scores were unchanged; the risk of potentially serious adverse effects is high. This therapy cannot be recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nerve-stimulator guided paravertebral blockade vs. general anaesthesia for breast surgery: a prospective randomized trial.
Different anaesthetic techniques are used during breast surgery but are frequently associated with unsatisfactory postoperative analgesia. Paravertebral nerve blockade has recently been proposed as a favourable alternative for this type of surgical procedure, providing excellent pain relief and a reduced incidence of postoperative nausea and vomiting. The aim of the present study was to compare the use of a nerve-stimulator guided paravertebral nerve blockade technique to regular general anaesthesia for breast surgery. ⋯ The use of paravertebral nerve blockade was associated with improved postoperative pain relief, a reduced incidence of nausea and vomiting after operation and a shorter duration of hospital stay compared to general anaesthesia in patients undergoing breast surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Improvement in postoperative pain relief by the addition of midazolam to an intrathecal injection of buprenorphine and bupivacaine.
Intrathecal injections of the benzodiazepine midazolam have been reported to cause antinociception in animals and pain relief in human beings, including the potentiation of opioid analgesia. This study compared the efficacy of the addition of midazolam to a mixture of buprenorphine and bupivacaine used for spinal anaesthesia. ⋯ We conclude that intrathecal midazolam 2 mg improves the quality and duration of postoperative pain relief afforded by intrathecal buprenorphine and bupivacaine.