Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the addition of three different doses of sufentanil to 0.125% bupivacaine given epidurally during labour.
In a double-blind, randomised, prospective study 150 women in labour received intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1:800,000) with 5, 7.5 or 10 micrograms of sufentanil added. The onset, duration, and quality of analgesia were compared. Motor block, type of delivery and neonatal Apgar scores were noted. ⋯ Motor blockade and type of delivery did not differ between the groups and there were no differences in neonatal Apgar scores. No patient required more than three injections. We conclude that 7.5 micrograms sufentanil is the optimal dose to add to intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1:800,000) for pain relief in labour.
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One hundred and sixty six patients were questioned by means of a multiple choice questionnaire, to determine their knowledge of peri-operative care, anaesthesia and the rôle of anaesthetists. In general, knowledge was good, but there were some important misconceptions; in particular, 28.3% of respondents thought that fasting referred to food only, and not to fluid intake. In addition, 47.6% of respondents considered pain to be a necessary part of the healing process and 38.6% believed that it was something that just had to be endured. When forthcoming anaesthesia is discussed, anaesthetists need to ascertain that patients really do understand the language used.
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Randomized Controlled Trial Comparative Study Clinical Trial
Difficulties in spinal needle use. Insertion characteristics and failure rates associated with 25-, 27- and 29-gauge Quincke-type spinal needles.
The effect of different size (25-, 27- and 29-gauge) Quincke-type spinal needles on the incidence of insertion difficulties and failure rates was investigated in a randomised, prospective study with 300 patients. The needle size was randomised but the insertion procedure was standardised. The time to achieve dural puncture was significantly longer with the 29-gauge spinal needle compared with the larger bore needles and was due to the greater flexibility of the thin needle. ⋯ Postoperatively, no postdural puncture headaches occurred in the 29-gauge spinal needle group, whilst in the 25- and 27-gauge needle groups, the postdural puncture headache rates were 7.4% and 2.1% respectively. The incidence of backache was similar in all study groups. We conclude that dural puncture with a 29-gauge spinal needle is clinically as easy as with larger bore needles and its use is indicated in patients who have a high risk of postdural puncture headache.