ABSTRACT
A prospective, randomised study of 82 patients having postoperative epidural analgesia was performed to determine whether the tunnelling of an epidural catheter influences its migration. Tunnelling of the catheter subcutaneously for a distance of 5 cm reduced the incidence of inward migration of 1 cm or more (p < 0.01) compared to a standard method of fixation with a transparent adhesive dressing. This effect was more marked if the epidural catheter was sited in the thoracic rather than the lumbar area. Sixty two percent (n = 26) of tunnelled catheters remained within 0.5 cm of their original position compared to 38% (n = 16) of non-tunnelled catheters, although this difference was not statistically significant. Outward catheter migration was not reduced by subcutaneous tunnelling.
Subject(s)
Analgesia, Epidural/methods , Catheterization, Peripheral/methods , Foreign-Body Migration/prevention & control , Pain, Postoperative/drug therapy , Bandages , Female , Humans , Male , Prospective StudiesABSTRACT
The efficacy of a single caudal epidural injection of bupivacaine 20 ml 0.5% following emergency orthopaedic surgery to the lower leg and ankle was investigated. Forty adult patients were studied, randomised to either the caudal or control group. The mean 24 hour postoperative papaveretum consumption was significantly reduced in the caudal group. Analogue pain scores as assessed in a double-blind manner were also significantly reduced in this group. The duration of analgesia after caudal blockade was approximately eight hours as estimated by the average time to the first dose of papaveretum. Our study demonstrates that caudal blockade represents an effective adjunct to intramuscular opiates following this type of surgery.
Subject(s)
Analgesia, Epidural , Ankle/surgery , Bupivacaine/therapeutic use , Leg/surgery , Nerve Block , Opium/therapeutic use , Pain, Postoperative/prevention & control , Adult , Bupivacaine/administration & dosage , Double-Blind Method , Emergencies , Female , Humans , Injections, Intramuscular , Injections, Intravenous , Male , Opium/administration & dosage , Pain Measurement , Sacrum , Time FactorsABSTRACT
Observations were recorded from two hundred consecutive insertions of the laryngeal mask airway (LMA). They were undertaken by 27 anaesthetists most of whom had no previous experience of its use. A clinically patent airway was obtained in 94% of patients and in the majority of these (76%) the LMA was positioned correctly at the first attempt. There were twelve cases of failed insertion. Nine of these were as a result of an inability to pass the LMA correctly into the hypopharynx while in the remaining three cases complete airway obstruction was reported. The insertion technique was easily acquired and trainee anaesthetists achieved a success rate of 84% for their first five attempts. Success with the LMA was related to experience: anaesthetists who had used the LMA over 15 times had no failures in 67 insertions. Twenty-two patients coughed and six developed mild laryngospasm at insertion. The incidence of postoperative sore throat was 8%.
