ED50 and ED95 of intrathecal levobupivacaine with opioids for Caesarean delivery.

BACKGROUND: This prospective randomized double-blind dose-response study aimed to determine the ED50 and ED95 of intrathecal levobupivacaine combined with morphine and sufentanil for elective Caesarean delivery. METHODS: Parturients undergoing elective Caesarean delivery were included and allocated to five levobupivacaine dose groups (6, 8, 10, 12, or 14 mg). Combined spinal-epidural (CSE) anaesthesia was performed, allowing intrathecal administration of the allocated dose of levobupivacaine with intrathecal morphine 100 µg and intrathecal sufentanil 2.5 µg, and insertion of epidural catheter for completing anaesthesia in the case of failure. The dose was considered as successful if a bilateral T6 sensory block to pinprick occurred in 15 min and if no epidural supplement was required during surgery. A probit regression analysis was performed to calculate the ED50 and ED95 of intrathecal levobupivacaine for Caesarean delivery. RESULTS: Eighty-five parturients were included. A block to T6 sensory level was reached in 15 min for most of the patients. The ED50 and ED95 of levobupivacaine were 6.2 mg (95% CI: 2.6-7.6) and 12.9 mg (11.1-17.9), respectively. Haemodynamic stability and the rate of nausea and vomiting were similar among groups. Greater doses of levobupivacaine were associated with increased motor block duration. CONCLUSIONS: When combined with intrathecal sufentanil 2.5 µg and intrathecal morphine 100 µg, the ED95 of intrathecal levobupivacaine is 12.9 mg for Caesarean delivery. If doses of levobupivacaine less than the ED95, particularly near the ED50, are used, these doses should be administered under a CSE technique.

Randomized trial of a low-molecular-weight heparin (Kabi 2165) versus adjusted-dose subcutaneous standard heparin in the prophylaxis of deep-vein thrombosis after elective hip surgery.

124 patients undergoing total hip replacement were randomly allocated to receive Kabi 2165, 2,500 anti-Xa units twice a day (group A); Kabi 2165, 2,500 anti-Xa units twice a day during the first 48 h postoperatively and then 5,000 anti-Xa units once a day (group B), or adjusted-dose standard heparin, monitored by activated partial thromboplastin time (group C). The first dose was given 2 h before surgery in the three groups. Deep-vein thrombosis (DVT) was detected by radiolabelled fibrinogen uptake and bilateral venography was performed in patients who had a positive scan. In patients who had a negative scan, bilateral venography was performed routinely the day before discharge from hospital. The frequency of DVT demonstrated by venography was 4.9% in group A, 7.3% in group B and 10% in group C. The difference between the three groups was not statistically significant. The incidence of proximal DVT was 2.4, 2.4 and 7.5%, respectively, for the three groups. There was no significant difference between the three groups with respect to mean estimated blood loss, the number of blood units transfused, wound hematoma formation, or hemoglobin and hematocrit levels.

[Meconial peritonitis. Recordings about six observations. Diagnostic and prognostic value of calcifications. Therapeutic given off (author's transl)]. / Les péritonites méconiales. Commentaires à propos de 6 observations. Valeur diagnostique et pronostique des calcifications. Conséquences thérapeutiques.

The authors report six cases of meconium peritonitis with intra-abdominal calcifications; surgical intervention was successful in four. In five patients, fibrocystic desease of pancreas was eliminated. Presenting this report, it is their intention to underline the good prognosis of calcifications which generally eliminate the meconium ileus.