European journal of anaesthesiology
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Clinical Trial Controlled Clinical Trial
Patient-controlled epidural diamorphine for post-operative pain: verbal rating and visual analogue assessments of pain.
Twenty-two patients were studied while receiving epidural analgesia with diamorphine after major lower abdominal surgery under combined regional and general anaesthesia. Epidural PCA began when the intraoperative epidural block with bupivacaine wore off enough for the patient to request treatment. It was started with 2 mg of diamorphine and continued with a reducible background infusion that was initially set at 0.2 mg h-1 and supplemented by on-demand doses of 0.2 mg, with a lockout time of 15 min. ⋯ The plasma morphine concentrations rose to a plateau by about 15 min, with concentrations within 95% CI from 0 to 11 ng mliters-1 (average 5 ng mliters-1. The VRS and VAS pain scores were analysed by a conservative approach that treated them as ordinal data, and by a parametric approach that treated them as interval data. Both approaches conveyed broadly similar information about the post-operative analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-operative intravenous continuous analgesia: comparison of buprenorphine, fentanyl and nalbuphine.
Continuous intravenous infusions of fentanyl, buprenorphine or nalbuphine were investigated to provide pain relief for patients after major abdominal surgery. Buprenorphine (n = 23) was given as a loading dose of 5 micrograms kg-1 and infused at 0.8 micrograms kg-1 h-1. Fentanyl (n = 20) was given as a loading dose of 2 micrograms kg-1 and infused at 0.7 micrograms kg-1 h-1. ⋯ The infusion rate was increased when analgesia was inadequate, and decreased if respiratory depression occurred. Mean doses were respectively 0.74 +/- 0.15 microgram kg-1 h-1 buprenorphine, 0.68 +/- 0.18 microgram kg-1 h-1 fentanyl, 83 +/- 21 micrograms kg-1 h-1 nalbuphine. Titration of continuous intravenous infusion of buprenorphine and fentanyl provided better analgesia than nalbuphine with smaller doses than those reported in similar studies allowing spontaneous breathing.
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Randomized Controlled Trial Clinical Trial
Intramuscular NSAIDS reduce post-operative pain after minor outpatient anaesthesia.
Two hundred healthy patients scheduled for elective minor gynaecological surgery under general anaesthesia were randomly allocated to one of four groups who received either diclofenac 75 mg intramuscularly (i.m.), ketorolac 30 mg i.m., diclofenac 50 mg orally, or 2 mL NaCl i.m. The drugs were administered 10-20 min prior to a standard anaesthetic. ⋯ Complaints about pain and need for post-operative analgesics were significantly less frequent in the two groups of patients receiving an intramuscular non-steroidal anti-inflammatory drug (NSAID), as compared to placebo. The patients who received 50 mg diclofenac orally, administered shortly before the procedure, had the same pain course as the placebo patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nausea and vomiting after laparoscopic surgery: a comparison of propofol and thiopentone/halothane anaesthesia.
Sixty ASA I and II patients scheduled for laparoscopic cholecystectomy or inguinal herniotomy were randomly assigned to one of two groups: Group one (n = 30): induction with thiopentone 4-6 mg kg-1, fentanyl 2 micrograms kg-1, pancuronium 0.03 mg kg-1, and succinylcholine 1 mg kg-1, maintainance with halothane (0.8-1.5%), and N2O in O2 (FiO2 = 0.33). Group two (n = 30): induction with propofol 2-3 mg kg-1, fentanyl 2 micrograms kg-1, pancuronium 0.03 mg kg-1, and succinylcholine 1 mg kg-1, maintainance with propofol 6-10 mg kg-1 h-1, and O2 in N2 (FiO2:0.33). ⋯ The overall incidence of emetic sequelae (nausea or vomiting) was 43% in group one and 23% in group two (P = 0.17). Patients with propofol anaesthesia had lower emetic scores and higher recovery scores compared with those after thiopentone/halothane anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Changes in respiratory pattern during induction of anaesthesia with sevoflurane: comparison of nasal and the oral breathing.
In order to test the hypothesis that the effects on ventilation of nasal inhalation of sevoflurane during induction of anaesthesia differ from those of oral inhalation, 20 patients underwent inhalation induction of anaesthesia with sevoflurane 5% either through the nasal route or the oral route. In 10 patients who breathed through the nose (N-group), there was an immediate decrease in tidal volume with no change in respiratory duration whereas no similar change was observed in the 10 patients who breathed through the mouth (O-group). The time from the start of sevoflurane inhalation to the onset of sleep was significantly shorter in the O-group compared with the N-group [86.2 +/- 4.4 (mean +/- SE) vs. 115.0 +/- 8.4 sec, P < 0.01].