Anaesthesia
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Randomized Controlled Trial Clinical Trial
The optimal dose of ketamine for caudal epidural blockade in children.
Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml.kg-1 of 0.25% bupivacaine with 0.25 mg.kg-1 of preservative-free ketamine, group B received 1 ml.kg-1 of 0.25% bupivacaine with ketamine 0.5 mg.kg-1 and group C received 1 ml.kg-1 of 0.25% bupivacaine with 1 mg.kg-1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. ⋯ There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.
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The inadequacies of conventional intramuscular opioid analgesia have fueled an expansion in the use of patient-controlled analgesia and epidural analgesia after surgery. This is not always accompanied by increased education and specialist supervision of ward staff and patients. ⋯ Frequent review of patients and regular education of ward staff by a specialist Pain Nurse have achieved a substantial reduction in side effects of epidural analgesia and improvement in efficacy of patient-controlled analgesia. We have shown that the advantages of patient-controlled analgesia can be largely negated by failure to address deficiencies in knowledge of pain management among ward staff and patients.
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Editorial Historical Article
150 years of ether anaesthesia and what is next?
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of prophylactic ondansetron and metoclopramide administration in patients undergoing major neurosurgical procedures.
In a prospective, randomised, double-blind trial, we assessed the relative efficacy of prophylactic ondansetron and metoclopramide administration in the reduction of postoperative nausea and vomiting in 60 patients undergoing routine major neurosurgical procedures. The patients were randomly allocated into one of two groups. ⋯ Patients who received metoclopramide experienced less postoperative nausea and vomiting than those who received ondansetron in the 48 h following surgery (17 (56%) versus 9 (30%) p = 0.038). In the light of these findings, we believe that ondansetron is an inappropriate agent for the prevention of postoperative nausea and vomiting in the neurosurgical population.
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Two cases are reported of sciatic nerve palsy after delivery by Caesarean section in primigravidae. One mother was slender and had an emergency Caesarean section for failure to progress with a breech presentation. Epidural analgesia during labour was extended for operative delivery. ⋯ She experienced severe intrapartum hypotension. Both patients suffered right sided sciatic nerve palsy. The aetiologies of obstetric palsies and those following regional block are reviewed and the importance of careful diagnosis and of avoiding peripheral nerve compression during regional block are emphasised.