Oxycodone--an audit of its prescription in a local hospital.

AIM: This study aims to evaluate the prescription patterns and side effects of oxycodone in a local hospital setting. MATERIALS AND METHODS: This is a retrospective analysis of all patients who were prescribed oxycodone for acute or chronic pain from June to November 2007. Patients' names were obtained from the hospital pharmacy and data were collected with a set of questionnaire after review of their casenotes. Prescription was compared with other recommended opioid prescription guidelines. Side effects to oxycodone use were documented. RESULTS: One hundred and thirty patients were prescribed oxycodone for the 6-month study period. Prescription by the orthopaedic surgeons was the highest, followed by the pain service. Most patients had a clear indication for use of oxycodone and appropriate dosing regimes. However, two thirds of the patients prescribed oxycodone were not reviewed with regard to their analgesia within 24 hours and one third did not have titration of the drug to their pain symptoms. Majority of the patients had outpatient follow-up within 4 weeks of discharge. Common side effects included nausea, vomiting and constipation. CONCLUSION: This is the first local audit that profiles oxycodone prescription patterns and its side effects. Prescription of oxycodone was appropriate for the majority of the study population. Patient assessment upon initiation of oxycodone therapy and titration of the drug to patients' pain symptoms was suboptimal. Oxycodone was well tolerated by the study population with minimal side effects. Further quality measures and ongoing education of clinicians will ensure future patients obtain safe and effective analgesia.

Electrical stimulation of the epidural space using a catheter with a removable stylet.

BACKGROUND AND OBJECTIVES: Electrical stimulation can be used to verify the location of epidural catheters. With the traditional technique, the latter must be primed with saline to allow for electrical conduction: any air lock will, thus, hinder the flow of current. Therefore, we set out to explore an alternative mode of stimulation by use of a catheter containing a removable stylet. This study examines the reliability of this new technique. METHODS: In 71 patients undergoing surgery, a thoracic epidural catheter was inserted preoperatively. Loss of resistance was used to identify the epidural space. The TheraCath was introduced 5 cm into the space and connected to a neurostimulator via a 2-headed alligator clip. The intensity, pulse width, and level of myotomal contractions were recorded upon stimulation of the epidural space. A bolus of lidocaine was then injected and the patient assessed for sensory block to ice. RESULTS: The failure rate in proper epidural catheter placement was 8.5%. Epidural stimulation yielded a mean threshold of 1.90 +/- 1.80 nanocoulombs. A total of 37 catheters produced a unilateral muscular response; however, block to ice was bilateral. When compared with the ice test, the sensitivity, specificity, positive predictive value, and negative predictive value of epidural stimulation with the TheraCath were 92%, 83%, 98%, and 50%, respectively. CONCLUSION: We conclude that the TheraCath, because of the removable stylet, provides effective electrostimulation of the epidural space. Its use was simple and devoid of complications. Nonetheless, further studies are required before implementing its routine use in clinical settings.

Intrathecal labor analgesia using levobupivacaine 2.5 mg with fentanyl 25 microg--would half the dose suffice?

BACKGROUND: This randomized, double-blinded, controlled trial of 40 patients in early labor was conducted to determine whether a reduction in the total amount of intrathecal levobupivacaine and fentanyl would reduce the incidence of motor blockade and pruritus, respectively. MATERIAL/METHODS: Combined spinal epidural (CSE) analgesia was instituted. Group A (n=20) received 2.5 mg levobupivacaine with 25 microg fentanyl intrathecally while group B (n=20) received half that dose. RESULTS: The duration and quality of spinal analgesia were comparable in the 2 groups. There was a reduced incidence of motor blockade in patients from Group B (P<0.01). This was apparent 5 minutes after the spinal injection and persisted throughout the next 30 minutes. However, there were also 2 parturients from this group who required epidural supplementation as a result of partial analgesia. Other side effects were not different between the 2 groups. CONCLUSIONS: A reduction in the intrathecal dose of 2.5 mg levobupivacaine with 25 microg fentanyl by half is an option for CSE in labor because it can reduce the incidence of motor impairment. Although the reduced dose does not differ significantly from the full dose with respect to onset, duration, and quality of analgesia for the majority of parturients, it must be highlighted that insufficient labor analgesia may occur in certain individuals. In this respect, further studies related to dosage of intrathecal levobupivacaine in obstetric labor analgesia will be beneficial in substantiating this point.