British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Ketorolac, diclofenac and ketoprofen are equally efficacious for pain relief after total hip replacement surgery.
We have compared the efficacy of ketorolac 30 mg i.v. followed by infusion at a rate of 90 mg/15.5 h, with that of diclofenac 75 mg followed by infusion of 75 mg/15.5 h or ketoprofen 100 mg followed by infusion of 100 mg/15.5 h, on postoperative pain in 85 patients after hip replacement surgery under spinal anaesthesia in a prospective, double-blind, randomized study. Supplementary analgesia was administered during the 16-h postoperative period with bolus doses of fentanyl delivered by a patient-controlled analgesia system. ⋯ Median VAS scores were low over the entire study in each group and there was no significant difference between groups. No serious adverse events were recorded.
-
Randomized Controlled Trial Clinical Trial
Does speed of intrathecal injection affect the distribution of 0.5% hyperbaric bupivacaine?
We have evaluated the influence of speed of intrathecal injection on lateral distribution of 0.5% hyperbaric bupivacaine. We studied 60 patients undergoing lower limb surgery who were placed in the lateral position with the operative side in the dependent position. After dural puncture (25-gauge Whitacre spinal needle), the needle aperture was turned towards the dependent side and 0.5% hyperbaric bupivacaine 8 mg was injected randomly at a rate of 0.02 ml s-1 (group slow, n = 30) or 0.25 ml s-1 (group fast, n = 30). ⋯ There were no differences between the groups. Forty-five minutes after patients were turned to the supine position, spinal anaesthesia was unilateral in 17 patients in group slow (56%) and in 13 patients in group fast (43%). We conclude that using extremely low speeds for intrathecal injection were not clinically advantageous in obtaining unilateral spinal anaesthesia.
-
Randomized Controlled Trial Comparative Study Clinical Trial
High-dose ondansetron regimen vs droperidol for morphine patient-controlled analgesia.
We have performed a randomized, double-blind study comparing droperidol and high-dose ondansetron mixed with morphine for patient-controlled analgesia (PCA). To detect a reduction in the incidence of postoperative nausea and vomiting from 55% to 20% with a power of 80% at the P < 0.05 level, 29 patients per group were required. We studied 60 healthy women undergoing abdominal hysterectomy, anaesthetized using a standard technique. ⋯ In group D, 24 patients did not vomit compared with 23 in group O. The only significant difference between the groups was increased morphine consumption in the ondansetron group up until 12 h after operation (P < 0.05), but by 24 h this difference was not significant. The ondansetron regimen was more expensive (at local prices) by a factor of 27, and our results suggested no clinical advantage over droperidol.
-
Randomized Controlled Trial Clinical Trial
Factors affecting assessment of cerebral autoregulation using the transient hyperaemic response test.
The transient hyperaemic response in the middle cerebral artery blood flow velocity on the release of brief compression of the ipsilateral common carotid artery has been validated as an indicator of cerebral autoregulation. We evaluated, in three stages, the effect of experimental factors such as duration of compression of the common carotid artery and magnitude of the decrease in blood flow velocity during common carotid artery compression on the transient hyperaemic response. In stage 1, 13 healthy volunteers underwent six transient hyperaemic response tests each; two tests each for either 3, 6 or 10 s duration of compression of the common carotid artery. ⋯ We conclude that experimental factors such as duration of common carotid artery compression and magnitude of the decrease in blood flow velocity during common carotid artery compression can significantly influence the transient hyperaemic response. These factors should be controlled if the transient hyperaemic response test is used for a comparison between repeated measurements. A compression time of 10 s and a compression ratio of 40% or more, allow maximum expression of the hyperaemic response in healthy volunteers.
-
Randomized Controlled Trial Clinical Trial
Effect of preoperative extradural bupivacaine and morphine on stump sensation in lower limb amputees.
We have examined the effect of preoperative extradural bupivacaine and morphine on postoperative stump sensation in 31 patients undergoing amputation of the lower limb in a prospective, randomized, double-blind study. Patients were allocated randomly to one of two groups: group 1 received extradural 0.25% bupivacaine 4-7 ml h-1 and morphine 0.16-0.28 ml h-1 before and during operation; group 2 received extradural saline before and during amputation and conventional analgesics for pain treatment. All patients received general anaesthesia for the amputation and extradural bupivacaine and morphine after operation. ⋯ The following were measured: pressure pain thresholds (pressure algometry), touch and pain detection thresholds (von Frey hairs), thermal sensibility (thermal rolls), and allodynia and wind-up-like pain. There were no differences between the two groups at any of the postoperative assessments for mechanical and thermal sensibility or rate of allodynia and wind-up-like pain. Our study suggests that preoperative and intraoperative extradural block had no long-term prophylactic effect on hyperalgesia, allodynia or wind-up-like pain.