British journal of anaesthesia
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Randomized Controlled Trial
Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery.
The landmark-guided transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing lower abdominal surgery. We evaluated the analgesic efficacy of the ultrasound (US)-guided TAP block in patients undergoing Caesarean delivery. ⋯ The US-guided TAP block reduces morphine requirements after Caesarean delivery when used as a component of a multimodal analgesic regimen. Registered with the Australia New Zealand Clinical Trials Registry ACTRN12608000540314. URL: http://www.anzctr.org.au/trial_view.aspx?ID=83176.
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Review Meta Analysis
Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression.
Various techniques and drug regimes for thoracic paravertebral block (PVB) have been evaluated for post-thoracotomy analgesia, but there is no consensus on which technique or drug regime is best. We have systematically reviewed the efficacy and safety of different techniques for PVB. Our primary aim was to determine whether local anaesthetic (LA) dose influences the quality of analgesia from PVB. ⋯ Continuous infusions of LA predicted lower pain scores compared with intermittent boluses (P=0.04 at 8 h, P=0.003 at 24 h, and P<0.001 at 48 h). The use of adjuvant clonidine or fentanyl, pre-emptive PVB, and the addition of patient-controlled opioids to PVB did not improve analgesia. Further well-designed trials of different PVB dosage and drug regimes are needed.
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The role of the endogenous opioid system in the anaesthetic effect of volatile anaesthetics and the analgesic action of nitrous oxide (N2O) is unclear. In the current study, we investigated whether the mu-opioid receptor (MOP) is involved in these activities using MOP knockout (MOP-KO) and wild-type (WT) mice. ⋯ These results suggest that MOP is not required for the anaesthetic action of volatile anaesthetics and the analgesic effect of N2O. Opioid receptors other than MOP may mediate the analgesic action of N2O.
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Randomized Controlled Trial Comparative Study
Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia.
Comparing the relative potency of new local anaesthetics such as levobupivacaine and ropivacaine with bupivacaine by the minimum local analgesic concentration model has not been described for neonatal spinal anaesthesia. This information is important to compare agents and to determine the most effective spinal dose. ⋯ Appropriate doses for infant spinal anaesthesia are 1 mg kg(-1) of isobaric 0.5% bupivacaine and ropivacaine and 1.2 mg kg(-1) of isobaric 0.5% levobupivacaine.
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Randomized Controlled Trial Comparative Study
Comparison of sub-Tenon's block with i.v. fentanyl for paediatric vitreoretinal surgery.
Vitreoretinal (VR) surgery is associated with moderate to severe pain and significant postoperative nausea and vomiting (PONV). The study aimed to assess the effectiveness of sub-Tenon's block for providing perioperative analgesia in children undergoing VR surgery. ⋯ Sub-Tenon's block provides more effective analgesia than i.v. fentanyl for paediatric VR surgery.