British journal of anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Psychological characteristics and the effectiveness of patient-controlled analgesia.
We have evaluated the level of state and trait anxiety, neuroticism, extroversion and coping style as predictors of the effectiveness of patient-controlled analgesia (PCA) in 110 patients undergoing total abdominal hysterectomy. After operation patients were allocated to receive pain control with either PCA or i.m. injections (IMI). Pain was assessed using the short form McGill pain questionnaire at 6, 18 and 24 h after operation, and by recording the amount of analgesic consumed in the first 24 h after surgery. ⋯ Patients using PCA experienced significantly better pain control than those receiving IMI. However, it was those with high levels of state anxiety who experienced the greatest reduction in pain with PCA. In addition to achieving better pain control, patients who received PCA used significantly less analgesia and were discharged earlier than patients who received IMI.
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Randomized Controlled Trial Clinical Trial
Post-tetanic burst: a new monitoring method for intense neuromuscular block.
A new stimulation pattern for evaluation of intense neuromuscular block (post-tetanic burst (PTB)) was compared with post-tetanic twitch (PTT) during spontaneous recovery from vecuronium-induced neuromuscular block. Thirty adult patients were allocated to two equal groups and we measured times from administration of vecuronium 0.1 mg kg-1 to return of PTB and PTT responses, and evoked responses to PTB and PTT stimuli. For PTB stimulation, a 50-Hz tetanus was applied at 50 mA for 5 s, and after a pause of 3 s, a 50-Hz burst stimulation was applied, consisting of three impulses at 50 mA. ⋯ Similarly, PTT consisted of a tetanus, a 3-s pause and one single twitch stimulation repeated every 5 min. Time to return of the PTB response was significantly shorter than that of PTT (mean 23.7 (SD 7.9) compared with 30.7 (7.0) min) (P = 0.0160), although evoked responses to PTB did not differ significantly from those of PTT throughout recovery from vecuronium-induced neuromuscular block. This study suggested that PTB was more sensitive in evaluating intense neuromuscular block than PTT.