ABSTRACT
BACKGROUND: 2-Chloroprocaine (2-CP) used for lumbar epidural anesthesia (LEA) reportedly decreases the efficacy of epidural morphine (EM) administered for post-cesarean section (CS) analgesia. The amount of supplemental i.v. morphine self-administered by the patient via the patient-controlled analgesia device (PCA) is used to study the interaction between EM and 2-CP. METHODS: Forty-two patients scheduled for elective CS were randomly divided into 3 equal groups, and received 2-CP, 2-CP + epinephrine (Epi, 5 micrograms.ml-1) or 2% lidocaine (Lido) with Epi for LEA. All patients received 5 mg EM and i.v. PCA morphine for postoperative pain. Cumulative amount of i.v. morphine used in the first 24 hours as well as the amount of the drug used during each 2-h period were noted. Nonparametric analysis of variance and Chi-squared analysis were used for statistical comparisons. RESULTS: The mean cumulative 24-h i.v. PCA morphine requirement in the 2-CP, 2-CP+Epi and Lido+Epi groups respectively was 20.5 +/- 24, 33.1.5 +/- 27 and 4.07 +/- (mean +/- SD). The Lido + Epi group used significantly less morphine (P = 0.01) compared to either of the 2-CP groups with no significant difference between the 2-CP groups. The maximum i.v. PCA morphine use occurred in the first 4 hours following surgery in all three groups. CONCLUSION: Analgesic efficacy of EM is decreased when 2-CP is used for LEA compared to when Lido + Epi is used.
Subject(s)
Analgesia, Epidural , Analgesia, Obstetrical , Anesthesia, Epidural , Anesthetics, Local/pharmacology , Morphine/antagonists & inhibitors , Procaine/analogs & derivatives , Adult , Analgesia, Patient-Controlled , Female , Humans , Pregnancy , Procaine/pharmacologyABSTRACT
The purpose of this double-blind, randomized study was to compare the effectiveness of ondansetron plus saline versus ondansetron plus dexamethasone in the prevention of postoperative nausea and vomiting. Of 180 women having general anesthesia for major gynecologic surgery, 89 received intravenous ondansetron, 4 mg, plus saline (Group 1) and 91 received intravenous ondansetron, 4 mg, plus dexamethasone 8 mg (Group 2) during their operation. A complete response, defined as no emesis and no need for rescue antiemetic during the 24-h postoperative period, occurred in 38% of patients in Group 1 and in 52% in Group 2 (P = 0.048). Emesis occurred in 34% of patients in Group 1 and in 15% in Group 2 (P = 0.003). Nausea scores were significantly lower for patients in Group 2 at 2 h (P = 0.023) and at 24 h (P = 0.001). In the ondansetron plus dexamethasone group, 9 out of 10 patients who received propofol for induction of anesthesia had no emesis. The only failure occurred in a patient who had a single emetic episode during the 24th postoperative hour. The combination of ondansetron and dexamethasone was more effective than ondansetron and saline in the prevention of postoperative nausea and vomiting for women having major gynecologic surgery.
Subject(s)
Dexamethasone/administration & dosage , Nausea/prevention & control , Ondansetron/therapeutic use , Postoperative Complications/prevention & control , Vomiting/prevention & control , Adolescent , Adult , Aged , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Middle Aged , Ondansetron/administration & dosageABSTRACT
The incidence of postoperative effects of droperidol, in the hospital and at home the following night, after general anesthesia for minor outpatient procedures was evaluated in two groups of 50 patients each. Anesthetic techniques were identical except for the presence or absence of 1.25 mg of IV droperidol. There were no differences between the groups with regard to postoperative nausea, vomiting, pain, or time to discharge. In 23% of patients given droperidol, anxiety or restlessness developed after discharge from the ambulatory care unit. No patient not receiving droperidol had these reactions. It is suggested that the routine use of droperidol in all outpatients receiving general anesthesia may not be appropriate.
