British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Normal postoperative gastric emptying after orthopaedic surgery with spinal anaesthesia and i.m. ketorolac as the first postoperative analgesic.
We have assessed the effect of i.m. ketorolac or morphine on early postoperative gastric emptying of liquids in patients undergoing orthopaedic surgery with spinal anaesthesia. Liquid gastric emptying was measured by absorption of paracetamol with patients acting as their own controls. There was no delay after ketorolac 30 mg, but morphine 10 mg resulted in marked delay. There was no difference in postoperative visual analogue pain scores between treatments.
-
Comparative Study
Transient radicular irritation after spinal anaesthesia with hyperbaric 5% lignocaine.
We have studied prospectively 600 patients who had spinal anaesthesia for minor surgery, to evaluate the incidence of transient radicular irritation after the block. The anaesthetic agent (hyperbaric 5% lignocaine, hyperbaric 0.5% bupivacaine or plain 0.5% bupivacaine) was chosen according to the anticipated duration of surgery. We obtained information after operation from 537 patients (282 by telephone, 255 by letter). ⋯ Two patients complained of symptoms after hyperbaric 0.5% bupivacaine but these were atypical compared with pain after lignocaine. None of the patients anaesthetized with plain bupivacaine had similar complaints. We conclude that the use of 5% hyperbaric lignocaine for spinal anaesthesia should be reconsidered.
-
To determine the effects of cardiopulmonary bypass (CPB) on tracheal cuff pressure, we have measured intracuff pressure (ICP) in 29 consecutive patients undergoing cardiac surgery with CPB. Premedication comprised hyoscine and, after induction of anaesthesia with diazepam and fentanyl, followed by vecuronium, the trachea was intubated using a Portex Profile tracheal tube. Anaesthesia was maintained with high-dose fentanyl and 100% oxygen. ⋯ ICP changed significantly during CPB, decreasing to 8.0 (1.0) mm Hg before rewarming (P < 0.01 vs immediately before CPB) and increasing to 17.0 (0.6) mm Hg after the start of rewarming (P < 0.01 vs before rewarming). After CPB, ICP did not differ significantly from that immediately before CPB. We conclude that the decrease in ICP during the hypothermic phase of CPB may protect the tracheal mucosa against hypotensive ischaemic injury.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ropivacaine and bupivacaine in extradural analgesia for the relief of pain in labour.
Forty women having requested extradural analgesia for labour were allocated randomly to receive 0.5% ropivacaine or bupivacaine 10 ml as the main dose. When a top-up was requested, 0.25% ropivacaine or bupivacaine 10 ml was given (the same drug as the main dose). The study ended when a second top-up was requested or delivery of the baby occurred. ⋯ Sensory block and motor block were assessed at intervals. The only significant difference between the groups was a shorter onset of pain relief after the main dose of bupivacaine; there were no other significant differences in duration, onset of pain relief after top-up, quality of analgesia, spread of sensory block and motor block between the groups. Cardiovascular changes and neonatal outcome were similar in the two groups.