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Spinal anaesthesia for Caesarean section and fetal acidosis.
Collis RE, Harris SE.
Publication Types:
PMID: 16288625 [PubMed - in process]
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A randomised comparison of the Portex Softseal laryngeal mask airway with the LMA-Unique during anaesthesia.
Cook TM, Trumpelmann P, Beringer R, Stedeford J.
Royal United Hospital, Combe Park, Bath, UK. timcook@ukgateway.net
We have compared the performance of the single use laryngeal airway devices Softseal and LMA-Unique in a randomised comparative trial in anaesthetised healthy patients who did not receive neuromuscular blockade. Primary outcome was success of airway placement. Secondary outcomes included manipulations and complications during use, ease of insertion, airway and fibreoptic assessment of airway positioning, and complications postoperatively. We planned to study 300 patients but interim analysis demonstrated the study should be stopped after 100 patients. During insertion the Softseal required more attempts for successful insertion (p = 0.041), more manipulations (p < 0.0001) and caused more complications (p = 0.048). Failure of placement occurred in five cases with the Softseal and none with the LMA-Unique (p = n/s). Two Softseal needed to be removed during maintenance because of airway obstruction, giving an overall failure rate of seven (p = 0.013). Serial tests of positioning favoured the LMA-Unique (p = 0.012). Ventilation was more successful in the LMA-Unique group but the difference was not significant (p = 0.051). Seal pressure was higher with the Softseal (26.5 vs. 20.5 cmH(2)O, p = 0.005). Fibreoptic view via the devices was not statistically significantly different. During maintenance of anaesthesia more complications arose with the Softseal (p = 0.03). Anaesthetist ratings of ease of insertion and overall usefulness favoured the LMA-Unique (p < 0.0001 and p = 0.024, respectively). After anaesthesia, sore throat occurred more frequently and was more severe in those patients anaesthetised with a Softseal both in recovery (p = 0.015) and at 24 h (p = 0.012). We conclude that the Softseal performs less well and causes more complications than the LMA-Unique.
PMID: 16288620 [PubMed - in process]
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Military influence upon the development of anaesthesia from the American Civil War (1861-1865) to the outbreak of the First World War.
Metcalfe NH.
Centre for the History of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom. neilmetcalfe@doctors.org.uk
The American Civil War (1861-1865) helped cement the place of anaesthesia in American medical practice and offered new insights into the specialty. The advantages that ensued were to offer long-term security to anaesthesia but the short-term gains were negligible. The Franco-Prussian War (1870-1871) exerted a negative influence upon nitrous oxide and oxygen research through the loss of leading civilian scientists to military duty. Later, the Boer Wars (1899-1902) helped stabilise the popularity of chloroform after the Hyderabad Commissions but were of little experimental value to anaesthesia. In the early 20th Century, the military continued to be operational without either specialist anaesthetists or an interest in developing military anaesthesia. However, the lack of anaesthetic development was largely due to problems with economics and academic infrastructure rather than to simple military neglect.
PMID: 16288619 [PubMed - in process]
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Recombinant activated factor VII and the anaesthetist.
Welsby IJ, Monroe DM, Lawson JH, Hoffmann M.
Department of Anaesthesiology, Duke University Medical Center, Durham, NC 27710, USA. welsb001@mc.duke.edu
Recombinant activated factor VII is a safe and effective for the treatment and prevention of haemorrhage in haemophiliacs with circulating inhibitors to replacement factors, and patients with Glanzmann's thrombasthenia refractory to platelet transfusion. By restoring thrombin generation on the surface of tissue factor bearing cells, such as activated platelets and monocytes, recombinant activated factor VII has the potential to effect haemostasis in the setting of many coagulopathic states encountered by the anaesthetist in the operating theatre or the intensive care unit. Case reports of successful rescue therapy make up the majority of the literature covering other, numerous, off-label uses of recombinant activated factor VII, although some randomised, controlled studies, mostly underpowered to address safety concerns, have been performed. However, off-label use is becoming increasingly popular judging by the number of published case reports. Additional randomised, controlled trials to determine the safe and appropriate use of this potentially valuable therapy in broader patient groups are eagerly awaited.
PMID: 16288618 [PubMed - in process]
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Comparison of the effects of intrathecal morphine and pethidine on shivering after Caesarean delivery under combined-spinal epidural anaesthesia.
Hong JY, Lee IH.
Department of Anaesthesiology, Samsung Cheil Hospital, Sungkyunkwan University, Mukjeong-Dong 1-19, Jung-Gu, Seoul (100-380), South Korea. jenyhongg@hanmail.net
We performed a prospective, randomised, double blind study to compare the antishivering effect of morphine and pethidine when added to intrathecal hyperbaric bupivacaine during elective Caesarean delivery under combined-spinal epidural anaesthesia. Spinal anaesthesia consisted of either 8-10 mg of 0.5% bupivacaine alone (group B; n = 30) with 0.1 mg morphine (group BM0.1; n = 29), with 0.2 mg morphine (group BM0.2; n = 30), or with 10 mg pethidine (group BPeth10; n = 30). The incidences of shivering were 23.3% (7/30) in group B, 17% (5/29) in group BM0.1, 13.3% (4/30) in group BM0.2 and 3.3% (1/30) in group BPeth10 (p < 0.05). The shivering intensity for each patient was significantly higher in group B than the other groups. In conclusion, intrathecal pethidine added to hyperbaric bupivacaine reduces the incidence and intensity of shivering more than does morphine (0.1 or 0.2 mg).
PMID: 16288613 [PubMed - in process]
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A novel method of nasogastric tube insertion.
Reid S, Falconer R.
Publication Types:
PMID: 16229711 [PubMed - indexed for MEDLINE]
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Use of the common gas outlet for supplementary oxygen during Caesarean section.
Edsell ME, Erasmus PD.
Publication Types:
PMID: 16229709 [PubMed - indexed for MEDLINE]
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Sevoflurane delivery via the Triservice apparatus.
Mellor A, Hicks I.
Publication Types:
PMID: 16229708 [PubMed - indexed for MEDLINE]
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A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position.
Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D.
Intensive Care, St George's Hospital, Sydney, Australia.
We investigated whether positioning patients undergoing general anaesthesia for cholecystectomy in a 20 degrees head-up position, as opposed to supine, improved the efficacy of 3 min of standard pre-oxygenation via a circle breathing system. Following pre-oxygenation, patients received a standard induction of anaesthesia and the apnoea time (from administration of rocuronium to the arterial oxygen saturation to fall to 95%) was recorded. Mean (95% CI) apnoea time was 386 (343-429) s in the 20 degrees head-up position (n = 17) vs 283 (243-322) s in the supine position (n = 18; p = 0.002). Pre-oxygenation is significantly more efficacious and by inference more efficient in the 20 degrees head-up position than in the supine position.
Publication Types:
PMID: 16229689 [PubMed - indexed for MEDLINE]
Factors influencing the discomfort of intraoral needle penetration.
Meechan JG, Howlett PC, Smith BD.
School of Dental Sciences, University of Newcastle Upon Tyne, England. J.G.Meechan@ncl.ac.uk
This study with 24 volunteers compared the discomfort produced by needle penetration in different parts of the palatal mucosa. In addition, comparing a fresh needle to one that was used for a previous penetration in the same patient, we assessed the influence of the status of the needle on insertion discomfort during buccal mucosal penetration. The results showed that needle penetration in the anterior hard palate was more uncomfortable than in the posterior palate. Although men could not differentiate between fresh and used needles for a second buccal mucosal penetration, women reported a significant increase in discomfort with used needles.
Publication Types:
PMID: 16252738 [PubMed - indexed for MEDLINE]
Comment on:
Exhausting waste gases.
Pickles J.
Publication Types:
PMID: 16215553 [PubMed - indexed for MEDLINE]
Permanent anosmia after topical nasal anaesthesia with lidocaine 4%.
Salvinelli F, Casale M, Hardy JF, D'Ascanio L, Agro F.
Publication Types:
PMID: 16286355 [PubMed - in process]
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Additional use for adenosine in anaesthesia and surgery.
Kakazu C, Lippmann M, White RA.
Publication Types:
PMID: 16286352 [PubMed - in process]
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Diathermy does not reduce subconjunctival haemorrhage during sub-Tenon's block.
Kumar CM, Williamson S.
Publication Types:
PMID: 16155045 [PubMed - indexed for MEDLINE]
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Adjuncts to caudal block in children--Quo vadis?
Lonnqvist PA.
Publication Types:
PMID: 16155039 [PubMed - indexed for MEDLINE]
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Effects of pre-eclampsia on maternal plasma, cerebrospinal fluid, and umbilical cord urotensin II concentrations: a pilot study.
Cowley E, Thompson JP, Sharpe P, Waugh J, Ali N, Lambert DG.
University Department of Cardiovascular Sciences (Pharmacology and Therapeutics Group), Division of Anaesthesia, Critical Care and Pain Management, University of Leicester, Leicester Royal Infirmary, UK.
BACKGROUND: Urotensin II (UII) is the most potent endogenous vasoconstrictor identified to date. Pre-eclampsia is associated with arteriolar vasospasm but the precise underlying mechanism is uncertain and we hypothesized that UII concentrations might also be elevated. In this study we measured UII concentrations in maternal plasma and cerebrospinal fluid (CSF), and umbilical vein plasma from pre-eclamptic (PET) and normotensive patients undergoing elective Caesarean section under spinal or combined spinal-epidural anaesthesia. METHODS: With LREC approval and informed consent we recruited two groups of 10 patients; control [mean (range) age, 29 (22-43) yr; BMI, 25 (20-32); gestation, 273 (267-281) days; mean arterial pressure (MAP) on day of delivery, 81 (75-96) mm Hg] and PET [age, 34 (22-40) yr; BMI, 25 (21-46); gestation, 253 (203-289) days; MAP on day of delivery, 106 (88-128) mm Hg]. Maternal blood and CSF samples and umbilical vein blood samples were taken. UII was extracted and concentrations measured using a radioimmunoassay. RESULTS: Two plasma and two CSF samples in the control and two CSF samples in the PET group were below the assay detection limits. There were no differences in maternal plasma or CSF or umbilical vein UII concentrations between the groups. However, there was a small ( approximately 40%) but significant increase in cord UII concentrations when compared with paired plasma in the PET group. There was a weak but significant negative correlation (r=-0.4, P=0.049) between cord UII concentrations and gestation in the PET group. In addition, we observed a significant positive correlation between plasma and CSF (r(2)=+0.57, P=0.0009, n=16), plasma and cord (r(2)=+0.43, P=0.0031, n=18) and CSF and cord (r(2)=+0.32, P=0.022, n=16) UII concentrations for the whole data set. CONCLUSIONS: Collectively the data indicate that UII concentrations do not increase in PET compared with controls but, in PET patients, cord UII concentrations are elevated relative to paired plasma samples. Elevated umbilical vein UII concentrations may simply indicate reduced placental viability and possibly UII metabolism as a result of reduced blood flow or possibly that the placenta is producing UII.
PMID: 16126783 [PubMed - indexed for MEDLINE]
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Pharmacokinetics of levobupivacaine after caudal epidural administration in infants less than 3 months of age.
Chalkiadis GA, Anderson BJ, Tay M, Bjorksten A, Kelly JJ.
Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia.
BACKGROUND: There are few data describing levobupivacaine pharmacokinetics in infants (<3 months) after caudal administration. METHODS: An open-label study was undertaken to examine the pharmacokinetics of levobupivacaine 2.5 mg ml(-1), 2 mg kg(-1) in children aged less than 3 months after single-shot caudal epidural administration. Plasma concentrations were determined at intervals from 0.5 to 4 h after injection. A population pharmacokinetic analysis of levobupivacaine time-concentration profiles (84 observations) from 22 infants with mean postnatal age (PNA) 2.0 (range 0.6-2.9) months was undertaken using non-linear mixed effects models (NONMEM). Time-concentration profiles were analysed using a one-compartment model with first-order input and first-order elimination. Estimates were standardized to a 70 kg adult using allometric size models. RESULTS: Population parameter estimates (between-subject variability) for total levobupivacaine were clearance (CLt) 12.8 [coefficient of variation (CV) 50.6%] litre h(-1) 70 kg(-1), volume of distribution (Vt) 202 (CV 31.6%) litre 70 kg(-1), absorption half-life (Tabs) 0.323 (CV 18.6%) h 70 kg(-1). Estimates for the unbound drug were clearance (CLfree) 104 (CV 43.5%) litre h(-1) 70 kg(-1), volume of distribution (Vfree) 1700 (CV 44.9%) litre 70 kg(-1), absorption half-life (Tabsfree) 0.175 (CV 83.7%) h 70 kg(-1). There was no effect attributable to PNA on CL or V. Time to peak plasma concentration (Tmax) was 0.82 (CV 18%) h. Peak plasma concentration (Cmax) was 0.69 (CV 25%) microg ml(-1) for total levobupivacaine and 0.09 (CV 37%) microg ml(-1) for unbound levobupivacaine. CONCLUSIONS: Clearance in infants is approximately half that described in adults, suggesting immaturity of P450 CYP3A4 and CYP1A2 enzyme isoforms that metabolize levobupivacaine in infants. This lower clearance delays Tmax, which was noted to occur approximately 50 min after administration of caudal epidural levobupivacaine.
PMID: 16100236 [PubMed - indexed for MEDLINE]
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An unusual complication of interscalene brachial plexus catheterization: delayed catheter migration.
Jenkins CR, Karmakar MK.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories. carolinejenkins@cuhk.edu.hk
This case report describes the delayed migration of an interscalene brachial plexus catheter that was inserted for postoperative analgesia and to facilitate physiotherapy after shoulder surgery. Approximately 18 h after surgery the catheter was found to have migrated into the interpleural space, which could have resulted in a serious complication, namely a pneumothorax.
Publication Types:
PMID: 16051648 [PubMed - indexed for MEDLINE]
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Effect of epidural volume extension on dose requirement of intrathecal hyperbaric bupivacaine at Caesarean section.
Beale N, Evans B, Plaat F, Columb MO, Lyons G, Stocks GM.
Queen Charlotte's and Chelsea Hospital, London, UK.
BACKGROUND: The technique of epidural volume extension (EVE) involves the injection of saline into the extradural space immediately following the intrathecal injection, as part of a combined spinal-epidural (CSE) anaesthetic. One of the suggested benefits of EVE is a reduction in local anaesthetic required. The aim of this study was to test this hypothesis by comparing the median effective doses (ED50) of hyperbaric bupivacaine with fentanyl 25 microg with and without EVE for Caesarean section. METHODS: Sixty women were randomized to receive either CSE anaesthesia with EVE (EVE group) or no EVE (NEVE group). Using a double-blinded, up-down sequential technique, varying doses of bupivacaine with fentanyl 25 microg were administered. ED50 was estimated from up-down reversals and probit regression. RESULTS: The ED50 for bupivacaine was similar and not significantly different in the two groups (5.1 mg in the EVE and 6.1 mg in the NEVE group; difference 1.0 mg, 95% CI -0.12 to 2.2, P=0.08). CONCLUSIONS: This study illustrates that whilst low doses of intrathecal bupivacaine can be effectively used for Caesarean section, at such doses EVE does not appear to offer reliable or clinically relevant reductions in dosing with intrathecal bupivacaine.
Publication Types:
PMID: 16040637 [PubMed - indexed for MEDLINE]
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Clinical actions of subarachnoid sevoflurane administration in vivo: a study in dogs.
Garcia-Fernandez J, Parodi E, Garcia P, Matute E, A-Gomez-de-Segura I, Cediel R, Gilsanz F.
Department of Paediatric Anaesthesia, University Hospital La Paz, Madrid, Spain. ventilacionpediatrica@hotmail.com
BACKGROUND: Halogenated ethers produce clinical effects at spinal sites. Nevertheless, in vitro and in vivo studies have not determined whether the immobilizing effect in the spinal cord is due to inhibition of nociceptive or motor transmission or both. Our goal was to characterize the clinical effects of direct spinal sevoflurane administration. METHODS: Five adult beagle dogs completed the study. In a randomized and blinded manner each animal received placebo (saline 0.1 ml kg(-1)) and three concentrations of pure sevoflurane administered intrathecally (0.05, 0.075 and 0.1 ml kg(-1)) by means of a permanent spinal catheter. Sensory and motor block and state of consciousness were determined at baseline and at predetermined regular intervals until at least 2 h after total recovery. RESULTS: None of the dogs presented a decrease in consciousness with either 0.05 or 0.075 ml kg(-1) of sevoflurane. Administration of 0.1 ml kg(-1) produced light sedation (2 on a four-point sedation scale) in three of the five dogs. A comparison of the duration of the sensory and motor blocks among the three sevoflurane dosages shows a significant dose-dependent increase that is greater in all cases than that for the saline solution. CONCLUSIONS: Spinal administration of pure sevoflurane resulted in a dose-related and totally reversible motor and sensory regional block without any signs of clinical neurotoxicity or significant decrease in consciousness. Therefore the model allows us to comment on the analgesic effects at the spinal level in addition to the direct immobilizing effects of sevoflurane.
PMID: 16040635 [PubMed - indexed for MEDLINE]
Medium-/long-chain triglyceride emulsion reduced severity of pain during propofol injection.
Nagao N, Uchida T, Nakazawa K, Makita K.
Publication Types:
PMID: 15983165 [PubMed - indexed for MEDLINE]
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Using a Glidescope for intubation with a double lumen endotracheal tube.
Hernandez AA, Wong DH.
Publication Types:
PMID: 15983163 [PubMed - indexed for MEDLINE]
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Another method to assist nasogastric tube insertion.
Mahajan R, Gupta R.
Publication Types:
PMID: 15983156 [PubMed - indexed for MEDLINE]
Comment in:
Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital.
Burkle CM, Walsh MT, Harrison BA, Curry TB, Rose SH.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. burkle.christopher@mayo.edu
PURPOSE: The purpose of this single-centre database review was to establish the incidence of failure to intubate by direct laryngoscopy, to measure morbidity and mortality associated with this event, and to examine the use and efficacy of alternative airway devices. METHODS: Difficult intubation via direct laryngoscopy at Mayo Clinic Rochester is recorded in an electronic database using a functional classification: 0 = no difficulty; 1 = mild to moderate difficulty; and 2 = severe difficulty often requiring a change in intubation technique. Using this database, the total number of intubations was determined for a selected review period and the incidence of failure to intubate by direct laryngoscopy was established. Abstraction of chart data allowed for determination of associated morbidity and mortality, success of alternative airway devices, and case cancellation rate. RESULTS: During the period from August 1, 2001 through December 31, 2002, 37,482 patients underwent general anesthesia with attempted direct laryngoscopy. One hundred sixty-one patients (0.43%) could not be intubated by direct laryngoscopy alone. Morbidity associated with difficult intubation included soft tissue/dental damage (n = 8), intraoperative cardiac arrest (n = 1), and possible aspiration (n = 1). Three patients required intensive care unit admission. There was no associated mortality. The most commonly used alternative airway device was the flexible fibreoptic scope. Five case cancellations resulted from failure to intubate with alternative devices. CONCLUSION: The rate of unexpected failure to intubate by direct laryngoscopy is essentially unchanged from earlier studies. While morbidity was low, continued education and early use of alternative difficult airway devices may further limit complications associated with this event.
PMID: 15983152 [PubMed - indexed for MEDLINE]
Comment in:
The Proseal LMA is a useful rescue device during failed rapid sequence intubation: two additional cases.
Cook TM, Brooks TS, Van der Westhuizen J, Clarke M.
Department of Anaesthesia, Royal United Hospital, Combe Park, Bath, United Kingdom. timcook@ukgateway.net
PURPOSE: We report two cases where the ProSeal laryngeal mask airway (PLMA) was successfully used as a rescue device, after failed tracheal intubation, during rapid sequence induction. CLINICAL FINDINGS: The first case involved a 31-yr-old primigravida presenting for emergency Cesarean section for severe fetal distress. She had a grade 3 larynx and airway edema was observed during laryngoscopy. Attempts with a McCoy blade and gum elastic bougie failed to secure the airway. A size 4 PLMA was inserted with good airway control and surgery proceeded uneventfully. The second case involved a 51-yr-old man presenting for appendectomy. Following failed attempts at intubation, a size 5 PLMA was successful in securing his airway and surgery proceeded uneventfully. CONCLUSIONS: The correctly placed PLMA has potential advantages over the cLMA for airway rescue in the circumstance of failed emergency intubation in a patient with a potentially full stomach. In the two cases reported, the PLMA provided effective rescue of the airway.
Publication Types:
PMID: 15983151 [PubMed - indexed for MEDLINE]
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Labour analgesia guided by echocardiography in a parturient with primary dilated cardiomyopathy.
Okutomi T, Saito M, Amano K, Fukuoka K, Hoka S.
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. toshiyukiokutomi@hotmail.com
PURPOSE: To evaluate the effects of intrathecal analgesics on cardiac function during labour analgesia using echocardiography in a parturient with idiopathic dilated cardiomyopathy (DCM). CLINICAL FEATURES: Induction of labour was planned in a 35-yr-old primiparous woman suffering from DCM. In order to stabilize hemodynamics in this patient, we induced continuous spinal analgesia with an infusion of fentanyl and epinephrine. Although her analgesia was well maintained for three hours during the first stage of labour, the patient complained of pain towards the second stage of labour. At this point, we administered bupivacaine intrathecally to alleviate her pain. Transthoracic echocardiography showed that the left ventricular end-diastolic and systolic dimensions, as well as the ejection fraction were not impaired by use of these analgesic medications. CONCLUSION: Measurement of left ventricular dimensions by echocardiography allowed us to monitor the patient's response to intrathecal analgesic medications. In this patient with DCM, analgesia with intrathecal fentanyl and bupivacaine was well tolerated.
Publication Types:
PMID: 15983149 [PubMed - indexed for MEDLINE]
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Subdural placement of an epidural catheter detected by nerve stimulation.
Lena P, Martin R.
Department of Cardiologie medico-chirurgicale, Institut Arnault Tzanck, Saint Laurent du Var, France. Pierre.Lena@wanadoo.fr
PURPOSE: Subdural placement of an epidural catheter is rare and difficult to detect. Electrical stimulation of the epidural space can be useful to detect such an event. The purpose of the present case report is to confirm the efficacy of electrical stimulation to detect a subdural placement of an epidural catheter and to illustrate this unusual positioning by computed tomography (CT) scan images. CLINICAL FEATURES: A 51-yr-old man was scheduled for an aorto-iliac bypass on a combined epidural and general anesthesia technique. Electrical epidural stimulation was used. A very low threshold of 0.3 mA was observed with diffuse response movement at T3 and at T10, without cerebrospinal fluid return on catheter aspiration. An injection of 12 mL of 2% lidocaine with epinephrine 1/200,000 produced signs of iv injection of local anesthetic and an extensive block. Subdural placement of the catheter, suspected by the low current threshold response to epidural catheter stimulation, was confirmed by CT scan imaging. CONCLUSION: The present case report confirms that electrical stimulation of the epidural space is useful to detect misplacement of epidural catheter such as a subdural placement. CT scan imaging of subdural positioning of an epidural catheter is presented.
Publication Types:
PMID: 15983148 [PubMed - indexed for MEDLINE]
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Ketorolac analgesia for inguinal hernia repair is not improved by peripheral administration.
Kardash KJ, Garzon J, Velly AM, Tessler MJ.
Department of Anesthesiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. kenneth.kardash@mcgill.ca
PURPOSE: It has been suggested that ketorolac, a non-steroidal anti-inflammatory drug (NSAID) available for parenteral use, may result in prolonged (24 hr) postoperative analgesia through a peripheral mechanism when added to local anesthetic infiltration. Our objective was to assess this effect by controlling for systemic absorption of the drug. METHODS: This randomized, double-blind trial studied 40 men undergoing elective inguinal hernia repair under spinal anesthesia. All patients received 19 mL of lidocaine 1% infiltrated in the operative field before incision. Patients were randomized into two groups of 20. The surgical site group received ketorolac 30 mg added to the lidocaine infiltration. In the control group, ketorolac 30 mg was injected subcutaneously in the contralateral abdominal wall. Numeric rating scores (0-10) of pain at rest and with movement were recorded at the time of discharge from the recovery room and at 24 hr postoperatively. Time to first analgesia, postoperative iv morphine use, total time in the recovery room, and total oral analgesic use in the first 24 hr were also compared. RESULTS: There were no significant differences between groups with respect to any of the measured variables. In both groups, pain scores were low at rest (1.9 +/- 1.4 vs 2.2 +/- 1.8, surgical site and systemic groups, respectively) and moderate with movement (5.3 +/- 2.2, 5.0 +/- 1.8) after anesthetic recovery. Pain scores were similar at 24 hr (1.1 +/- 1.3, 1.9 +/- 1.6 at rest; 5.7 +/- 2.0, 6.2 +/- 2.2 with movement). CONCLUSION: Adding ketorolac to lidocaine infiltration for hernia repair does not improve or prolong postoperative analgesia compared to systemic administration.
Publication Types:
PMID: 15983147 [PubMed - indexed for MEDLINE]
Comment on:
The unanticipated difficult airway--evolving strategies for successful salvage.
[Article in English, French]
Crosby E.
Publication Types:
PMID: 15983139 [PubMed - indexed for MEDLINE]
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