[Comparison of two oxytocin administration protocols in elective cesarean section: 5 iu versus 10 iu]

Background: Although Oxytocin is used systematically during caesarean section, no recommendation precise optimal dose for this indication. The bolus administration of 10 IU intravenously after extraction of the newborn, is accompanied by side effects mainly hemodynamic

Objectives: To compare two Oxytocin protocols: 05 IU bolus Vs. 10 IU bolus during Cesarean section by studying their respective effectiveness [effects on uterine tone] and adverse effects

Methods: A prospective randomized double-blind study including 87 term parturients for undergoing a C-section under loco regional anesthesia. Parturients were randomized into two groups depending on the injected Oxytocine dose: - Group 1 [n = 43]: 10 IU + 25 IU IVD in 500 ml of serum / 3h - Group 2 [n = 44]: 5 IU IVD + 25 IU in 500 ml serum / 3h

Results: The variation of the heart rate and the incidence of low blood pressure were significantly greater for Group 1. No significant differences between the two groups regarding blood loss was noticed per or postoperatively. The type of digestive side effects were more common in the first group

Conclusion: Administration of 5 units of Oxytocin during the scheduled C-sections is effective for uterine tone without superimposed bleeding risk, guarantees better hemodynamic stability and less side effects than the 10 units dose

[Postoperative analgesia after laparoscopic cholecystectomy comparison of the preoperative administration of celecoxib with paracetamol?]

The goal of this study was to evaluate the preventive analgesic effectiveness of paracetamol and celecoxib in laparoscopic cholecystectomy. Randomized prospective study was undertaken, 75 patients of class ASA I and II were included, divided into three groups: P [Paracetamol 1000 mg]. C [Celecoxib 200 mg] given orally one hour before induction and group T [without preoperative analgesia]. The VAS at rest and effort was noted on arrival in the recovery room then with regular intervals [T 30mn to T h24]. A morphine titration was carried out during the first 12 postoperative hours. Hemodynamic parameters. Ramsay score and the adverse effects were noted. The three groups were comparable for the demographic data, the duration of anesthesia and peroperative morphine consumption. The evolution of VAS scores shows a significant difference between the groups P and T with the effort of cough at t24h [p = 0.04], and between the groups C and T at postoperative T 4h [p = 0.016]. In our study the group C consumed to a significant degree less morphine 5.44 +/- 3.00 Mg against 7.83 +/- 4.00 Mg for the group P [p <0.03] and 8.04 +/- 3.00 Mg for the group T [p <0,008]. The administration of 200 Mg of celccoxib in the preoperative period of a laparoscopic cholecystectomy allows a significant decrease in morphine consumption in the postoperative period and a reduction in the scores of the VAS at rest and at the effort of cough compared to the groups which received only one placebo or paracetamol

[Patient controlled epidural analgesia: interest in thoracic surgery]

To compare efficacy of pain control, the consumption of local anaesthetics and opioids as well as the side effects between continuous epidural analgesia, patient controlled analgesia and patient controlled epidural analgesia in thoracic surgery. Prospective randomised study included 66 patients who had thoracotomy. Patients were divided into 3 groups, to receive different pain control methods. Group 1 [n=22] received patient control analgesia Group 2 [n=22] received continuous epidural analgesia [Bupivacaine 0,125% + 5 micro g/ml of Fentanyl] between 6 and 10 ml/h in order to obtain a T2 level Group 3 [n=22] received patient controlled epidural analgesia [Bupivacaine 0,08% + 3 micro g/ml of Fentanyl] 6ml/h and bolus of 5ml. There was no difference between the three groups in age, delay of surgical operation and per operative morphine consumption. VAS was less at rest and after cough in patient group with patient controlled epidural analgesia. The difference was less significant in local anaesthetics and opioids consumption in patient with controlled epidural analgesia. The benefit of patient controlled epidural analgesia in thoracic surgery is proven by the following analgesic efficiency which allows good respiratory rehabilitation, decreasing the risk of drug toxicity by decreases consumption, weak hemodynamic effects and absence of motor block

[Clinical benefits related to the combination of ketamine with morphine for patient controlled analgesia after major abdominal surgery]

Combination of ketamine may improve morphine patient controlled analgesia [PCA] but clinical results are still equivocal. The authors designed a powerful study to evaluate this hypothesis after major abdominal surgery. 138 patients undergoing abdominal surgery participated in the randomized double blind study. Patients were allocated to two groups: M-group: morphine 0.5 mg/ml + placebo in PCA and MK-group: morphine 0.5 mg/ml + ketamine 0.5 mg/ml with the same bolus dose and lock out time. The patients were evaluated during 48 hours by visual analog scale [VAS], simplified verbal scale [SVS]. Side effects and amount of morphine used were monitored. The two groups are comparable for demographic data and surgery characteristics. From the 24th hour, morphine consumption was significantly lower in the MK-group. At 48 hours after surgery, the amount of morphine received in the MK-group was significantly lower than in the M-group [48 vs 66 mg, p.<0.001]. The average value of VAS was lower in the MK-group from the 12th hour at rest and 20th hour during mobilization. SVS was significantly lower for the MK-group after the 12th postoperative hour. The incidence of respiratory depression was higher in the M-group: 4 vs none in the MK-group. The incidence of nausea, vomiting and pruritus was halved in the MK-group [p <0.04]. The combination of ketamine with morphine in PCA after major abdominal surgery offers a reduction of the morphine consumption, a reduction of pain scores and a decrease in the incidence of adverse effects

Efficacy of patient controlled epidural analgesia during labor analgesia - a prospective randomized study using 0.1% bupivacaine with fentanyl 2 microg/ml

Epidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics [LA] and driving block are the major limits of the modalities of maintenance. The purpose of this work was to assess efficiency and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia [PCEA]. 40 monofoetal parturients were randomized in two groups: 0.1% bupivacaine continuous drip associated to fentanyl 2 Ig/mL [CP-group] or same products administrated in PCEA. Evaluation of analgesia, driving and sensory block allows adapting the outputs of drip. Consumption schedule in LA was of 7.5 +/- 2 mL/h in the CP-group and 3.5 +/- 1.5 mL/h in PCEA-group [p < 0.05]. Consumption accumulated by LA is reduced by 35% from the very beginning and 43% a 4-th hour [p < 0.05]. Incidence of the driving block was of 11 cases in CP-group against 4 in PCEA-group per first hour and of 13 cases against 3 per second hour [p < 0.001]. 50% of clinical obstetric interventions were brought together in the CP-group against 5% in the PCEA-group [p = 0.013]. Incidence of side effects is comparable. Besides the perfect analgesia, PCEA offers a psychic independence which explains comfort and maternal satisfaction. Accumulation of LA entails a driving block involved in the change of dynamics of the labor. Incidence of clinical obstetric interventions is the major observation of our study