This prospective randomized single-blinded study was conducted to determine whether there were differences in consumption, demand dosing and postoperative analgesia quality between PCEA using ropivacaine and levobupivacaine. Seventy patients with ASA classification I and II aged 18 to 80 years old scheduled for elective total knee replacement or total hip replacement were studied. All patients received CSE and then were randomly allocated to receive either ropivacaine 0.165% (Group A) or levobupivacaine 0.125% (Group B) both added with fentanyl 2.0 mcro g/ml via epidural route. PCEA regime was offered for 48 hours with additional standard orthopaedic practice of oral analgesia (etoricoxib 120 mg OD and paracetamol 1.0 gm QID) on the second postoperative day. Basal infusion of PCEA was at 3.0 ml/hour and discontinued after 24 hours following started of PCEA. The consumption of local anaesthetics used within the first 24 hours (basal + demand) and 48 hours (total basal + total demand) were recorded. The VAS pain score, sedation score, side effects and vital signs (blood pressure, heart rate and respiratory rate) were also recorded every four hours for 48 hours. This study showed that the total volume of drug used was significantly higher in Group A (163.31+/- 29.01 ml) than Group B (142.69 +/- 30.93ml) (p<0. 01). The mean dose of Group A for the first 48 hours after surgery was 251.43 +/- 70.02mg and was significantly greater than the mean dose of Group B (178.91 +/-42.33 mg) (p<0.01). The numbers of PCEA boluses delivered (D) and PCEA attempts (A) were higher in the Group A (22.37 +/-7.32 and 27.66 +/- 9.12) in contrast to Group B (17.63 +/- 7.71 and 24.40 +/- 11.51) but the differences were not statistically significant. The ratio D/A showed significantly higher in Group A (0.83 +/- 0.13) than Group B (0.74 +/- 0.15) (p<0. 02). The VAS pain score was similar for both groups. One patient in Group B had vomiting and there was no sedation, hypotension, pruritus or motor block recorded in both groups. In conclusion this study showed that both PCEA using ropivacaine 0.165% with fentanyl 2.0 micro g/ml and levobupivacaine 0.125% with fentanyl 2.0 micro g/ml provided effective postoperative analgesia within the first 48 hours of major lower limb orthopaedic surgery despite clinically significant dose difference. There was no hypotension, pruritus, sedation or motor block recorded in both groups.
BACKGROUND: This was a double-blinded, prospective randomized controlled trial to compare the postoperative analgesia, side effects profile and overall satisfaction in patients who received intrathecal fentanyl with or without morphine for elective Caesarean.
METHODS: Sixty ASA I and II parturients were randomized into two groups. Group I received intrathecal fentanyl with 0.1 mg morphine and Group II received intrathecal fentanyl only. Postoperatively, all patients were provided with oral analgesics. The degree of post-operative pain score was assessed by verbal pain score. The incidence of side effects was assessed every 4 hours for 24 hours, which included incidence of nausea, vomiting, pruritus, sedation and evidence of respiratory depression. Patient's overall satisfaction was also recorded.
RESULTS: The verbal pain score was significantly lower in morphine group up to 20 hours postoperative period. The incidence of pruritus, nausea and vomiting were statistically significant up to 12 hours postoperative. There was no incidence of severe side effects in all the patients. There was significant difference between the morphine and no morphine group in terms of overall patient satisfaction.
CONCLUSION: There was significant difference in terms of lower pain score, higher incidence of side effects with better patients' overall satisfaction in morphine group.
Postoperative sore throat after minor pediatric surgery although uncommon and the symptoms are mild, the incidence may be affected by several factors. This study was designed to compare the frequency and severity of post operative sore throat in children undergoing elective surgery following the use of proseal LMA (PLMA) compared to classic LMA (cLMA).
We report a case of cardiac arrhythmia occurring in a Guillain-Barré syndrome (GBS) patient after succinylcholine administration during third endotracheal intubation, on day 13 of illness. The probable cause of arrhythmia is succinylcholine-induced hyperkalemia. Of interest, this case demonstrated in the same patient that arrhythmia only occurred during third intubation, when duration of illness is prolonged, and not during previous two intubation episodes, despite succinylcholine was also being used. In GBS, muscle denervation resulted in up-regulation of acetylcholine receptors at neuromuscular junctions, causing the muscle cell membrane to become supersensitive to succinylcholine, leading to severe hyperkalemia and arrhythmia when succinylcholine was administered.