Anaesthesia
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A case of phrenic nerve paralysis following interpleural analgesia for cholecystectomy is reported. The pre-operative chest X ray was normal but chest X ray after cholecystectomy and interpleural analgesia revealed a raised right hemidiaphragm. This resolved after discontinuation of the interpleural analgesia and was probably a result of phrenic nerve paralysis produced by the interpleural local anaesthetic.
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Randomized Controlled Trial Comparative Study Clinical Trial
Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective caesarean section.
Ninety-seven parturients undergoing elective Caesarean section were allocated randomly to have their legs elevated to approximately 30 degrees on pillows or elevated and wrapped with elasticated Esmarch bandages or neither (controls) following spinal anaesthesia. All patients received intravenous crystalloid (20 ml.kg-1 over 20 min) prior to spinal injection and were placed in the left lateral tilt position. Significant hypotension was treated with intravenous ephedrine in 5 mg bolus doses. ⋯ There was no significant difference in the time of onset of hypotension between the groups. For those patients requiring ephedrine, there was no significant difference in mean dose requirements between the groups. The use of leg compression immediately postspinal provides a simple means of reducing the accompanying hypotension and should be used more widely.
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We observed the sensory, motor and cardiovascular changes occurring during subarachnoid infusion of bupivacaine 0.125% at 15 ml.h-1 in six patients. After 1 h, motor block and lower sensory levels were consistent and predictable but upper sensory levels were variable. There was a moderate decrease in systolic blood pressure. Regular assessments of motor block are more likely to detect accidental subarachnoid infusion than assessments of upper sensory level or measurements of blood pressure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural tramadol for postoperative pain relief.
The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. ⋯ The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).