British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural pain relief in labour: potencies of levobupivacaine and racemic bupivacaine.
We have compared the minimum local analgesic concentrations (MLAC) of levobupivacaine relative to racemic bupivacaine in a prospective, randomized, double-blind, sequential allocation study. Women in labour were given a 20-ml bolus of epidural levobupivacaine or bupivacaine diluted to a concentration determined by up-down sequential allocation. The initial concentration was 0.07% w/v for both drugs. ⋯ With regard to the commercial preparations, the potency ratio levobupivacaine: bupivacaine was 0.98 (95% CI 0.67-1.41), and this is unlikely to be of clinical relevance. In molar terms, the ratio was 0.87 (95% CI 0.60-1.25). With regard to toxicity, the evidence should be evaluated in the light of a possible 13% potency difference in molar concentration in favour of racemic bupivacaine.
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Biography Historical Article Classical Article
Postoperative analgesia and lung function: a comparison of morphine with extradural block. 1971.
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Randomized Controlled Trial Clinical Trial
Effect of infiltration with ropivacaine on blood loss during reduction mammoplasty.
Ropivacaine is a new aminoamide local anaesthetic agent. Unlike other agents in its class, such as bupivacaine, it has been found to be vasoconstrictive. We have sought to investigate if this property is clinically useful and may reduce surgical blood loss. ⋯ There was no significant difference between the two regimens for duration of surgery or amount of tissue excised; however, ropivacaine was associated with markedly greater intraoperative blood loss than bupivacaine (median 696 (range 305-1366) ml kg-1 vs 300 (169-608) ml kg-1; P = 0.04, Wilcoxon rank sum test). Postoperative blood loss was not significantly different between groups (116 (14-173) ml kg-1 vs 98 (13-332) ml kg-1; P = 0.69, Wilcoxon rank sum test). We conclude that the vasoconstrictive properties of ropivacaine were not sufficiently great to merit its use as a sole agent for infiltration before reduction mammoplasty.
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Randomized Controlled Trial Clinical Trial
Tenoxicam and paracetamol-codeine combination after oral surgery: a prospective, randomized, double-blind, placebo-controlled study.
We studied 90 adults undergoing surgical removal of at least both lower third molar teeth as day cases under standardized general anaesthesia. Patients were allocated randomly (with stratification for surgeon) to receive tenoxicam 40 mg, tenoxicam 20 mg or placebo i.v. at induction of anaesthesia and orally (effervescent tablets) with food on each of the subsequent 2 days. Panadeine (paracetamol 500 mg-codeine 8 mg) was given before operation and was available as needed for pain thereafter, to a limit of two tablets every 4 h. ⋯ Over the 6-day period, patients who received tenoxicam reported less pain on rest (area under the curve; P < 0.05) and less disturbance in sleep (P < 0.01) even though they used fewer Panadeine tablets (P < 0.05). Differences between tenoxicam 40 mg and 20 mg were not significant. There was no significant difference in nefopam requirements or side effects, and no adverse event attributable to the study medication.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability.
Midazolam is often used for paediatric premedication. We have compared two methods of administering midazolam intranasally in 44 surgical day-case children allocated randomly to receive midazolam 0.2 mg kg-1 as drops or midazolam 0.1 mg kg-1 from an intranasal spray device. Behaviour was recorded on a four-point scale by the parent, nurse and anaesthetist. ⋯ There was no significant difference in the assessments between observers. Midazolam by either method was equally effective but acceptability of the premedication was poor in both groups. Intranasal midazolam cannot be recommended as a method for routine premedication of young children.