Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2014
Randomized Controlled Trial Comparative StudyRandomised comparison of an end-hole, triple-hole and novel six-hole catheter for continuous interscalene analgesia.
Epidural analgesia studies and a recent continuous peripheral nerve block study suggest multi-hole perineural catheters perform better than end-hole catheters. Confounding catheter positioning issues limit interpretation of the latter study. One hundred and fifty-six patients receiving an anterolateral interscalene catheter for elective shoulder surgery were randomised to three groups: following out-of-plane ultrasound confirmation of the needle tip immediately lateral to the C5/6 roots, an end-hole (n=52), triple-hole (n=53) or six-hole (n=51) non-stimulating catheter was positioned 3 cm beyond the needle tip. ⋯ Catheter threading difficulty was more common for the square-tipped end-hole catheters (end-hole=19% versus triple-hole=6%, six-hole=0%, P >0.001). This study found no evidence to support catheter orifice configuration significantly affecting the quality of continuous peripheral nerve blockade. These findings are in contrast to epidural catheter studies, and suggest that anatomical factors have a significant bearing on whether multi-orifice catheters confer advantage over the single-orifice design.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialA randomised controlled trial of parecoxib, celecoxib and paracetamol as adjuncts to patient-controlled epidural analgesia after caesarean delivery.
The benefit of combining non-opioid analgesics with neuraxial opioids for analgesia after caesarean delivery has not been clearly established. Larger doses of paracetamol or cyclooxygenase-2 inhibitors have not been evaluated. A randomised, double blind, double-dummy, parallel group placebo-controlled clinical trial was conducted among women having elective caesarean delivery under spinal anaesthesia, followed by pethidine patient-controlled epidural analgesia. ⋯ There were no differences between groups for pethidine consumption, based on either intention-to-treat (median 365, 365, 405 and 360 mg in groups C, PC, PA and PCPA respectively, P=0.84) or per protocol analysis (17 major violations). Dynamic pain scores did not differ between groups but requirement for, and dose of, supplementary oral tramadol was least in group PCPA (incidence 23% versus 48%, 70% and 58% in groups C, PC and PA respectively, P=0.004). The addition of regular paracetamol, cyclooxygenase-2 inhibitors or both to pethidine patient-controlled epidural post-caesarean analgesia did not provide a pethidine dose-sparing effect during the first 24 hours.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialParecoxib and paracetamol for pain relief following minor day-stay gynaecological surgery.
Paracetamol and non-steroidal anti-inflammatory drugs are often administered for postoperative analgesia. Dilatation and curettage, with or without hysteroscopy, is a common day-stay procedure that is associated with pain that is partly mediated by prostaglandins. This study aimed to investigate the analgesic efficacy of adjunctive paracetamol and parecoxib in this setting. ⋯ There were no significant differences in patient satisfaction or recovery. We conclude that paracetamol or parecoxib does not produce a clinically important reduction in pain in this setting. Women having uterine curettage and receiving intravenous fentanyl do not appear to benefit from administration of these non-opioid analgesics.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialPatient factors associated with frequent clotting of dialysers during haemodiafiltration in critically ill patients: a post hoc analysis of a randomised controlled study.
Continuous haemodiafiltration (CVVHDF) is the main form of renal replacement therapy in critically ill patients with severe acute kidney injury. Clotting of the dialysers during CVVHDF is frequent, because most patients with acute kidney injury have an increased risk of bleeding and cannot be systemically anticoagulated. Using data from a randomised controlled trial comparing the efficiency of CVVHDF by placing the dialysis catheter tip at the right atrium or superior vena cava, this study assessed the patient factors associated with an increased risk of frequent clotting of the dialysers-defined by >1 dialysers clotted per day of CVVHDF. ⋯ Use of aspirin or clopidogrel, causes of acute kidney injury and daily dose of unfractionated heparin used were not significantly associated with the risk of frequent clotting of dialysers. In the multivariate parsimony model, only a high body mass index (odds ratio 1.06 per point increment, 95% confidence interval 1.01 to 1.13; P=0.036) and a high platelet count (odds ratio 1.84 per 100x10(9)/l increment, 95% confidence interval 1.17 to 2.91; P=0.009), both in a relatively linear fashion, were independently associated with an increased risk of frequent clotting of dialysers. Optimising the position of the tip of the dialysis catheter may be particularly important for patients with a high body mass index and platelet count in order to reduce frequent clotting of dialysers during CVVHDF.