Comparison of the effect of two dose schedules of oral omeprazole with oral ranitidine on gastric aspirate pH and volume in patients undergoing elective surgery.

We have compared gastric aspirate pH and volume at induction of anaesthesia in 222 patients who had received either omeprazole or ranitidine before elective operations. Omeprazole was given orally either as 40 mg on the evening before and 40 mg on the morning of surgery or as 80 mg on the morning of surgery. Ranitidine 150 mg was given orally on the evening before surgery and 2 h before anaesthesia. Treatment success was defined as aspirate pH > or = 2.5 and volume < 25 ml at induction of anaesthesia. Treatment was successful in 84% (95% confidence interval (CI) 73-91%) of patients in the omeprazole 40 + 40 mg group, 84% (95% CI 73-91%) in the ranitidine group and 73% (95% CI 61-83%) in the omeprazole 80 mg group. There were no statistically significant differences between the groups. Twelve patients in the omeprazole 80 mg group had gastric pH < 2.5 and four had volume > 25 ml. Only three patients had a gastric pH < 2.5 in the omeprazole 40 + 40 mg group and none had volume > 25 ml, which compared well with the ranitidine group. Omeprazole, given as 40 mg in the evening and 40 mg on the morning of operation, has a potential role for use in patients at risk for aspiration during general anaesthesia.

A double-blind comparison of parenteral morphine, placebo, and oral fenoprofen in management of postoperative pain.

A double-blind study comparing parenteral morphine, 8 mg, with parenteral placebo and with oral fenoprofen, 200 mg, for the relief of postoperative pain following outpatient surgery was undertaken in 90 patients. The study drugs were administered within 2 hours of the operation and the Visual Analogue Scale was used to assess pain intensity. Patients given placebos showed minimal change in mean pain intensity, whereas patients who received morphine had significantly less pain at all assessment periods. Pain relief in patients who received fenoprofen was, for the first 2 hours, better than following placebo but not as good as following morphine, but thereafter, there was no significant difference between the morphine and fenoprofen and both were significantly better than placebo. It is concluded that oral analgesics may be a useful alternative to the traditional parenteral analgesics for outpatient surgery.

Oral premedication with oxypertine.

The preoperative effects of oral oxypertine have been compared with those of papaveretum and atropine in 185 patients in a double-blind between-patient study. Oxypertine 20 mg given orally as a nocturnal sedative and again on the morning of operation produced relief of anxiety comparable to that of papaveretum 10 mg and atropine 0.6 mg. It is concluded that oxypertine may be of value in medication before anaesthesia.

Double-blind clinical trial of anaesthetic premedication for use in major day surgery.

Three anaesthetic premedication regimens have been compared by double-blind controlled trial in 158 patients undergoing day-case surgery for varicose veins or hernia. Atropine plus droperidol was superior to atropine plus diazepam or atropine alone in lessening nausea and vomiting and in reducing the need for postoperative analgesia.