European journal of anaesthesiology
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of tramadol with morphine for post-operative pain following abdominal surgery.
In a multi-centre, double-blind, randomized study involving 523 patients, the analgesic efficacy of tramadol was compared to that of morphine given in repeated intravenous boluses as required to control post-operative pain following abdominal surgery over 24 h. Intravenous administration of the study analgesic started as soon as the patient reported pain. Patients received an initial dose (either tramadol 100 mg or morphine 5 mg) and, if necessary, repeat doses of tramadol 50 mg or morphine 5 mg could be given on demand over the first 90 min. ⋯ Whilst responder rates reached 72.6% with tramadol and 81.2% with morphine, the treatments were statistically equivalent and the observed difference in the responder rates between the groups was within the predefined range of +/- 10%. Mean cumulative doses received by treatment responders amounted to 188.2 mg within the first 1.5 h and 157.1 mg during the subsequent 22.5 h in the tramadol group and 13.9 and 18.4 mg, respectively, in the morphine group. A high incidence of gastrointestinal adverse events were observed with both treatments mostly consisting of mild nausea, dry mouth, vomiting, dyspepsia and hiccups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Speed of onset of analgesic effect of intravenous ketorolac compared to morphine and placebo.
The speed of onset of analgesia following intravenous ketorolac, morphine and placebo was investigated in a single-dose, double-blind, randomized, parallel group study of 105 patients. The onset of analgesia was defined as the time at which the pain intensity score reached 50% of the baseline score in 25% of patients. ⋯ Pain reduction by at least 50% occurred in 25% of patients within 40 min (placebo), 15 min (morphine 5 mg), 6 min (morphine 10 mg) and 20 min (ketorolac 10 mg). The pain reduction time for morphine (10 mg) was significantly shorter than that for ketorolac (P = 0.01) or placebo (P < 0.01).
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous spinal anaesthesia versus single dosing. A comparative study.
Continuous and single dose spinal anaesthesia were compared in a prospective randomized fashion in 108 patients undergoing orthopaedic surgery. Continuous spinal anaesthesia was via a 20 gauge polyamide multiperforated catheter introduced through an 18 gauge Tuohy needle. Single-dose spinal anaesthesia was performed with a 24 guage x 103 mm Sprotte spinal needle. ⋯ Hypotension was more frequent in those receiving single doses (P < 0.05). Caudal rotation of the outlet needle orifice to advance the catheter correlated with inadequate analgesia (P < 0.01, r = 0.38). There were no significant differences in the incidence of post-operative complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Technical problems and side effects associated with continuous intrathecal or epidural post-operative analgesia in patients undergoing hip arthroplasty.
Fifty-five patients undergoing hip arthroplasty under spinal anaesthesia (4 ml of 0.5% plain bupivacaine) were randomized to receive post-operative analgesia either using an intrathecal or an epidural catheter. Associated technical problems and side effects were studied. In both groups per-operative analgesia was achieved with intrathecal 0.5% plain bupivacaine, 4 ml. ⋯ The number of side effects was 21 in the remaining spinal group (n = 20) and 18 in the 20 epidural group patients with successful infusions. One patient in the spinal catheter group developed postdural puncture headache. For post-operative pain relief the patients in the epidural group needed less supplementary intramuscular oxycodone (five doses/four patients) than the spinal group (17 doses/nine patients) (P < 0.05).
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Neuromuscular and cardiovascular effects of neostigmine and methyl-atropine administered at different degrees of rocuronium-induced neuromuscular block.
The neuromuscular and cardiovascular effects of neostigmine, 40 micrograms kg-1, and methyl-atropine, 7 micrograms kg-1, administered at different degrees of rocuronium-induced (600 micrograms kg-1) neuromuscular block were evaluated. In one group of patients spontaneous recovery was awaited (Group A; n = 20). Neostigmine and methyl-atropine were administered 2 minutes after rocuronium (Group B; n = 20) or at 25% twitch recovery (Group C; n = 20). ⋯ The initial rate of recovery (time until a TOF ratio of 0.2) in group B, i.e. 14.2 (4.5) [12.1-16.3] min, was significantly faster than in group C, i.e. 28.7 (5.3) [26.3-31.1] min. However, the time until clinically sufficient recovery (time until a TOF ratio of 0.7) was similar for groups B, i.e. 29.3 (9.5) [24.9-33.7] min and group C, i.e. 31.8 (5.6) [29.2-34.4] min, both significantly different from that of group A, i.e. 53.2 (14.5) [46.5-59.9] min. The increase in heart rate following neostigmine/methyl-atropine was more pronounced in the group reversed at 2 min after rocuronium (P < 0.01).