Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain.
A double-blind randomised clinical trial was undertaken in 40 patients undergoing major abdominal surgery. Postoperative pain relief was provided using epidural infusions of 0.06% bupivacaine with fentanyl 4 micrograms.ml-1 (n = 20) (group F) or with pethidine 1.5 mg.ml-1 (n = 20) (group P). Postoperative pain scores using a visual analogue scale (0-100 mm) were not significantly different between the two groups. ⋯ Nine patients were withdrawn from the study (four from group F, five from group P) due to failure of the epidural technique or other complications. Fourteen patients, equally distributed, required a total of 24 epidural 'top-ups' by an anaesthetist because of inadequate analgesia. We demonstrated no advantage with epidural pethidine over fentanyl when used by infusion in combination with bupivacaine in the management of postoperative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical lignocaine and thiopentone for the insertion of a laryngeal mask airway; a comparison with propofol.
We assessed conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult patients who received either thiopentone 5 mg.kg-1 preceded by 40 mg of topical lignocaine spray to the posterior pharyngeal wall or propofol 2.5 mg.kg-1 alone in a randomised, single-blinded trial. All patients received fentanyl 1 microgram.kg-1. ⋯ The decrease in systolic and diastolic blood pressure, following induction and the insertion of a laryngeal mask with propofol was significantly greater than following thiopentone (p < 0.05--systolic, p < 0.01--diastolic). We conclude that thiopentone preceded by topical lignocaine spray provides conditions for insertion of a laryngeal mask equal to those of propofol, with more haemodynamic stability and a shorter period of apnoea.