European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Epidural diamorphine infusions with and without 0.167% bupivacaine for post-operative analgesia.
Forty patients who underwent upper or mid-abdominal surgery were randomly allocated to receive a post-operative epidural infusion of 0.083 mg ml-1 of diamorphine in either 0.167% bupivacaine or 0.9% NaCl solution. The nursing staff, who were unaware of which solution was being infused, managed the patients' pain according to a standardized scheme. They adjusted the epidural infusion rates to 3, 5 or 7 ml h-1 according to the patient's hourly reports of pain on a four point verbal rating scale (none, mild, moderate or severe), aiming to use the lowest allowed infusion rate to prevent or reduce any pain that was more than mild. ⋯ Diclofenac was needed by six patients receiving diamorphine in saline and one receiving diamorphine in bupivacaine (P < 0.05). The range of average hourly epidural infusion rates was constrained by design to between 3 and 7 ml h-1 but the median of these values was 5 ml h-1 in the diamorphine-saline group and 3.35 ml h-1 in the diamorphine-bupivacaine group (P < 0.02). In patients receiving diamorphine in saline, a median of 6 (range 0-16) of the 24 h reports were of more than mild pain, whereas in the diamorphine-bupivacaine group, the corresponding figures were 2 (range 0-13) (P < 0.02)).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural infusions of sufentanil with and without bupivacaine: comparison with diamorphine-bupivacaine.
The requirements for supplementary 3 ml epidural injections of bupivacaine 0.5% (top-ups) were used in a randomized double-blind study to compare the effects of five types of thoracic epidural infusions given at 2.5 ml h-1 for the first 24 h after major surgery to the upper abdomen in 99 patients and the lower abdomen in 72. The infusions were: bupivacaine 0.167% alone; diamorphine 0.167 mg ml-1 (0.417 mg h-1) in bupivacaine 0.167%; sufentanil 2 micrograms ml-1 (5 micrograms h-1) in 0.167% bupivacaine; sufentanil 4 micrograms ml-1 (10 micrograms h-1) in 0.167% bupivacaine; and sufentanil 4 micrograms ml-1 (10 micrograms h-1) in normal saline. The patients who had upper abdominal surgery were on average older than those having lower abdominal surgery and a larger proportion of them were female. ⋯ Although the two sufentanil-bupivacaine mixtures were indistinguishable in analgesic effectiveness after either upper or lower abdominal surgery, the lower (5 micrograms h-1) dose rate of sufentanil gave a significantly higher average breathing rate and lower average PaCO2 for the first 24 h after lower (but not upper) abdominal surgery. Blood samples were taken (as an afterthought) from 11 patients receiving sufentanil 10 micrograms h-1, just before the epidural infusion was stopped. The concentrations were mostly above the range for systemic analgesia, but below the values that would have been expected if a steady state had been achieved.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-dural puncture headache: a comparison of the Sprotte and Yale needles in urological surgery.
One hundred elderly male patients undergoing transurethral surgery were allocated randomly to receive spinal anaesthesia with either a 26 gauge Yale needle or a 24 gauge Sprotte needle. Patients were visited within 48 h by an investigator who was unaware of the needle type used and specific enquiry was made about any headache which was characteristic of dural puncture. ⋯ This represents a highly significant (P < 0.005) reduction in the incidence of postdural puncture headache. The incidence of multiple attempts at dural puncture was also significantly (P < 0.05) reduced to 16% in the Sprotte group compared with 28% in the Yale group.
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Randomized Controlled Trial Clinical Trial
Haemodynamic response to fibreoptic versus laryngoscopic nasotracheal intubation under total intravenous anaesthesia.
Thirty ASA physical status I and II patients scheduled for elective maxillofacial surgery received total intravenous anaesthesia with propofol, fentanyl and atracurium and were randomly allocated to undergo either fibreoptic or orthodox nasotracheal intubation. Haemodynamic responses to intubation were similar for both techniques. ⋯ There was no significant difference in the time required to complete intubation. SpO2 and end-tidal CO2 were similar for both techniques.
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Randomized Controlled Trial Comparative Study Clinical Trial
Metabolic response to lower abdominal surgery: analgesia by epidural blockade compared with intravenous opiate infusion.
To determine whether the type of peri-operative analgesic regimen affects the metabolic response during and after surgery, we studied 19 women undergoing abdominal hysterectomy under propofol anaesthesia. Patients were randomized to receive either continuous intravenous opioid or a bupivacaine-opioid mixture through a lumbar epidural catheter. Total body oxygen consumption and carbon dioxide excretion, blood glucose and haemodynamic variables were determined up to 24 h after surgery. ⋯ In the post-operative period, the increase in oxygen consumption up to pre-operative values, the urinary nitrogen excretion and the changes in acute phase proteins were similar in both treatment groups. In contrast, the respiratory quotient was significantly higher in the lumbar epidural group than in the intravenous opioid group, 0.87 (SD 0.04) vs 0.77 (SD 0.06) (P < 0.05) and the hyperglycaemic response was more delayed in the epidural group. These data suggest that prolonged sympathetic blockade associated with epidural analgesia might contribute to better preservation of glucose homeostasis in the perioperative period.