Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1983
Case ReportsThe management of headache following accidental dural puncture in obstetric patients.
The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. ⋯ The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.
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Anaesth Intensive Care · Feb 1983
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for haemorrhoid surgery.
Seventy patients undergoing haemorrhoidectomy under general anaesthesia were randomly allocated to one of five treatment groups in order to compare the effectiveness of various caudal agents in the control of postoperative pain. Four groups were given a caudal injection of either 2% lignocaine, 0.5% bupivacaine, 2% lignocaine + morphine sulphate 4 mg or normal saline + morphine sulphate 4 mg, while the fifth (control) group did not receive an injection. The number of patients requiring postoperative opiates was significantly higher in the lignocaine group than in the morphine (p less than 0.05) and morphine-lignocaine (p less than 0.05) groups. ⋯ In those who received opiates, the mean analgesic period was 228 minutes in the control group, and was significantly longer following bupivacaine (577 min, p less than 0.01), morphine-lignocaine (637 min, p less than 0.05) and morphine (665 min, p less than 0.0). The mean analgesic period following lignocaine (349 min) was not significantly different from control. The incidence of catheterisation was lowest in those patients who did not receive caudal analgesia.
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Anaesth Intensive Care · Nov 1982
A three-year survey of an obstetric epidural service with top-up doses administered by midwives.
A three-year survey following the introduction of an epidural service to a maternity unit is presented. 1,438 epidural blocks were attempted (a rate of 30%). Provision of pain relief was the principal indication. There were no serious complications or sequelae although minor complications or difficulties of insertion were noted in 21%. ⋯ Satisfactory pain relief was achieved in 90% during the first stage of labour and 71% during delivery. Of those who delivered, 47% retained an urge to bear down and spontaneous delivery occurred in 43%. 89% of patients interviewed were fully satisfied with, or considerably helped by, the epidural block. Incremental epidural doses were managed by midwives and it is argued that the midwife is ideally suited to this role providing she is trained and experienced and can call for immediate anaesthetic assistance.