British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of percutaneous anaesthesia for venous cannulation after topical application of either amethocaine or EMLA cream.
We have compared, in a double-blind study, the efficacy of topical amethocaine cream 1 g (5% w/w) in alleviating the pain of venous cannulation with that of 5% EMLA cream 2.5 g. One hundred and twenty unpremedicated female patients undergoing minor gynaecological surgery, were allocated randomly to one of four groups: 5% EMLA cream 2.5 g for 30 min: 5% EMLA cream 2.5 g for 60 min; amethocaine cream 1 g (5% w/w) for 30 min; amethocaine cream 1 g (5% w/w) for 60 min. ⋯ In addition, a blinded observer assessed the patient's response to venous cannulation using a four-point rank score. Good analgesia was obtained in all groups and there was no statistically significant difference in pain scores between the groups.
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The American College of Surgeons' Advanced Trauma Life Support procedure teaches that blind nasotracheal intubation should be performed in the presence of a suspected or proven cervical spine injury in an unconscious but breathing patient who requires an artificial airway. We studied a group of non-anaesthetically trained graduates of the Advanced Trauma Life Support course and examined their skill in performing blind nasal intubations. ⋯ We conclude that, in British hospitals, blind nasotracheal intubation should not be recommended as the first line management in securing the airway of patients with suspected or proven cervical spine injury. Alternative techniques such as bag-and-mask ventilation with cricoid pressure or a laryngeal mask airway with cricoid pressure should be adopted until oral intubation with in-line traction is performed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Speed of onset of sensory block for elective extradural caesarean section: choice of agent and temperature of injectate.
We have studied the effects of choice of local anaesthetic and temperature of extradural injectate on speed of onset of sensory block for elective extradural Caesarean section in a double-blind trial in 120 women allocated randomly to one of four groups to receive either plain 0.5% bupivacaine or 2% lignocaine with 1:200,000 adrenaline at either room temperature or 38 degrees C. The onset time of lignocaine with adrenaline was shorter than that of bupivacaine regardless of temperature (P < 0.01). Warmed lignocaine produced the most rapid block overall (P < 0.025). The incidence of hypotension, ephedrine requirement, shivering, quality of analgesia and additional analgesic requirements were similar for all groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Addition of morphine to intra-articular bupivacaine does not improve analgesia after day-case arthroscopy.
We conducted a randomized, double-blind, controlled study in patients undergoing day-case knee arthroscopy to evaluate the analgesic effect, for 36 h after operation, of the addition of either 2 mg or 5 mg of morphine to intra-articular bupivacaine. Patients in group BM5 (n = 20) received 0.25% bupivacaine 40 ml with morphine 5 mg; patients in group BM2 (n = 20) received 0.25% bupivacaine 40 ml with morphine 2 mg and patients in group B0 (n = 18) received 0.25% bupivacaine 40 ml only. ⋯ There were no significant differences in pain scores, consumption of additional analgesia, or time to first request for analgesia between any of the groups. We conclude that, after day-case knee arthroscopy, no additional analgesic effect was afforded by the addition of morphine to intra-articular bupivacaine.