Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia after caesarean section with intramuscular ketorolac or pethidine.
We compared, in a double-blind randomised study, intramuscular ketorolac 30 mg (n = 49) and intramuscular pethidine 75 mg (n = 51) for analgesia after elective caesarean section under general anaesthesia. Anaesthesia was induced with thiopentone and suxamethonium and maintained with atracurium, nitrous oxide and isoflurane. Intravenous fentanyl 100 micrograms was given after delivery of the neonate. ⋯ However, four patients in the ketorolac group and six patients in the pethidine group requested no further analgesia within 24 hours. Pain VAS and overall assessment of analgesia was similar between groups, although more side-effects (nausea, dizziness) were noted in the pethidine group. Ketorolac 30 mg and pethidine 75 mg provided similar but variable quality of analgesia after caesarean section.
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Anaesth Intensive Care · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialTowards optimal analgesia after caesarean section: comparison of epidural and intravenous patient-controlled opioid analgesia.
The provision of optimal analgesia after caesarean section remains a challenge as satisfactory pain relief must be combined with patient satisfaction, including the ability to care for the newborn. In a prospective study of 132 patients, we have compared epidural analgesia with intravenous patient-controlled analgesia (IVPCA) after either epidural or general anaesthesia. Different bolus doses of opioid (pethidine 10 mg and 20 mg) in the IVPCA group were also compared. Although epidural morphine provided the greatest efficacy (average pain score out of 10 was 1.8 v. 2.9-3.4 for the other groups), IVPCA, especially with a bolus dose of 20 mg, and especially after epidural anaesthesia, provided the greatest patient satisfaction with the least side-effects.
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Anaesth Intensive Care · Aug 1993
Use of a new syringe pump (Springfusor) for muscle relaxant infusion.
A new spring-driven syringe pump (Springfusor 10, Go Medical Industries, Subiaco, W. A.) was evaluated for infusion of muscle relaxants in 50 surgical cases. ⋯ The Springfusor was found to be rugged, cheap and easy to use. It lacks dose flexibility but is suitable for continuous background infusion of muscle relaxants during surgery.
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Fifty-three patients presenting for minor gynaecological procedures received caudal blocks performed by residents. These residents used the standard technique which relied on the "give" felt as a needle penetrates the sacrococcygeal membrane and the loss of resistance to air when the needle is correctly placed. The "whoosh" test was noted by the supervising anaesthetist who did not reveal his findings to the residents. ⋯ The predictive value of a positive test was found to be 78%, 80.7% and 97.7% (P < 0.01) for a positive "give", loss of resistance and "whoosh" test respectively. Negative tests had no predictive value for "give" and loss of resistance whilst the predictive value of an absent "whoosh" was 100% (P < 0.05). Thus we conclude that the "whoosh" test is an excellent aid in the teaching of caudal anaesthesia.