The Effect of EMLA Cream on Patient-Controlled Analgesia with Remifentanil in ESWL Procedure: A Placebo-Controlled Randomized Study.

BACKGROUND: To alleviate stinging pain in the skin entry area and visceral discomfort in patients who are undergoing ESWL. OBJECTIVES: This study was designed to investigate the effectiveness of the EMLA cream in combination with remifentanil patient-controlled analgesia (PCA) in patients undergoing ESWL treatment. PATIENTS AND METHODS: Sixty patients were divided into two double-blind randomized groups. Those in the first group were administered 3-5mm of EMLA 5% cream on a marked area; the second group received, as a placebo, a cream with no analgesic effect in the same amount. All patients were administered a remifentanil bolus with a PCA device. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; postoperative side effects, agitation, and respiratory depression were measured after. Visual Analogue Scale (VAS) scores were taken preoperatively, perioperatively, directly postoperatively, and 60 minutes subsequent to finishing the procedure. RESULTS: There were no statistically significant differences in the frequency of PCA demands and delivered boluses or among perioperative VAS. No significant side effects were noted. Patient satisfaction was recorded high in both groups. CONCLUSIONS: EMLA cream offered no advantage over the placebo cream in patients undergoing ESWL with remifentanil PCA.

Intrathecal morphine reduces postoperative tramadol consumption in patients undergoing radical retropubic prostatectomy: a randomized trial.

BACKGROUND: Intrathecal (IT) morphine provides prolonged analgesia after major surgery. AIM: The aim of our study was to assess the impact of intrathecal morphine 200 µg on patient-controlled analgesia (PCA) tramadol consumptions and postoperative pain in patients who underwent radical retropubic prostatectomy (RRP) under general anesthesia. MATERIALS AND METHODS: In this prospective trial, 56 men who underwent radical retropubic prostatectomy (RRP) were randomized into 2 groups. Group M received intrathecal morphine (200 µg) before the induction of general anesthesia. Group C did not receive intrathecal morphine. Postoperative analgesia was provided with tramadol PCA. Pain scores, tramadol consumption, adverse effects, rescue analgesia were recorded. RESULTS: Total tramadol consumption at 24 hours and pain scores during 12 hours postoperatively were significantly lower in Group M compared with Group C (p < 0.05). Rescue analgesia and postoperative nausea were lower in Group M than in Group C (p < 0.05). CONCLUSIONS: Intrathecal morphine 200 µg provided a significant reduction in tramadol consumption, postoperative pain scores, rescue analgesia, and postoperative nausea after RRP without serious adverse effects.

The effect of head rotation on intraocular pressure in prone position: a randomized trial.

BACKGROUND AND OBJECTIVES: The increased intraocular pressure (IOP) - which decreases perfusion pressure on the optic nerve - increases by prone positioning (1). The aim of our study was to compare the effect of head rotation 45° laterally in prone position on the increase in IOP of upper placed and lower placed eyes in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: Forty-five patients were randomly divided into 2 Groups. IOP of the patients were recorded bilaterally in supine position before the operation had started. Patients were turned to prone position. The head was placed on a prone headrest without external direct compression to both eyes. Patients in Group I were kept in strictly neutral prone position where as patients in Group II were placed prone with their heads rotated 45° laterally to the right side. At the end of the operation, patients were turned to supine position and their IOP was measured immediately. RESULTS: There was no difference related to demographics, duration of surgery, blood loss and fluid input data. IOP values after surgery in prone position increased significantly compared to preoperative values in both groups (p < 0.05). After surgery in prone position IOP values of the upper positioned eyes in Group II were significantly lower than Group I and lower positioned eyes in Group II (p < 0.05). CONCLUSION: prone positioning increases IOP. In patients with prone position with a head rotation of 45° laterally, IOP in the upper positioned eye was significantly lower.