Rectal Diazepam Compared to Intramuscular Pethidine/Promethazine/Chlorpromazine with Regard to Gastric Contents in Paediatric Anaesthesia

Sixty children, aged 1—12 years, were investigated with regard to gastric pH and volume before general anaesthesia. Thirty children (group D) received diazepam 0.75 mg/kg b.w. rectally 1 h before anaesthesia. Thirty children (group L) received a "lytic cocktail" (pethidine 28 mg, promethazine 7 mg, chlorpromazine 7 mg per ml) 0.05 ml/kg b.w. intramuscularly 1 h before anaesthesia. The pH values were significantly higher and the amount of gastric juice was significantly lower in group L compared to group D. The number of children in group L with gastric juice volume exceeding 0.4 ml/kg and the number of children with pH less than 2.5 was significantly smaller compared to group D. The number of children with both gastric pH less than 2.5 and gastric juice volume greater than 0.4 ml/kg was significantly smaller in the group receiving "lytic cocktail" intramuscularly compared to the group receiving diazepam rectally. Bile-stained gastric contents was not related to the gastric pH.     

小剂量氯胺酮对腹部手术后舒芬太尼老年病人自控静脉镇痛效果的影响

目的 探讨小剂量氯胺酮对腹部手术后舒芬太尼老年病人自控静脉镇痛效果的影响.方法 择期拟行腹部手术病人60例,年龄65～82岁,ASA Ⅰ或Ⅱ级,随机分为3组(n=20):S组(舒芬太尼200μg)、K1组(舒芬太尼200μg+氯胺酮100 mg)和K2组(舒芬太尼200 μg+氯胺酮200 mg),于缝合皮肤前连接病人自控静脉镇痛泵,均采用生理盐水稀释至200 ml,负荷剂量5 ml,背景输注速率1 ml/h,按压单次给药剂量2 ml,锁定时间5 min.VAS评分≥分时,静脉注射哌替啶25 mg,记录术后48 h内哌替啶及镇痛泵药液的用量,观察恶心、呕吐、呼吸抑制等不良反应的发生情况.结果 与S组比较,K1组和K2组术后48 h内哌替啶用量均明显降低,K2组术后48 h内镇痛泵药液用量降低(P<0.05);与K1组比较,K2组术后48 h内哌替啶及镇痛泵药液的用量降低(P<0.05);各组术后48h内恶心发生率差异无统计学意义(P>0.05),未见其他不良反应发生.结论 小剂量氯胺酮可增强腹部手术后舒芬太尼老年病人自控静脉镇痛的效果;自控静脉镇痛泵中加入氯胺酮200 mg(生理盐水稀释至200 m1)时效果较好,且不增加不良反应的发生.     

Failure of Intramuscularly Administered Lorazepam and Scopolamine-Morphine Premedication to Produce Amnesic Effects to Supplement Conduction Anaesthesia

Patients undergoing surgery under regional anaesthesia often prefer to be sedated and do not later want to recall the procedure. One hundred and twenty-one patients scheduled for various surgical procedures under epidural, spinal, sacral, or brachial plexus blockades received 1 mg/kg of pethidine, 0.007 mg/kg of scopolamine, plus 0.14 mg/kg of morphine, or 0.03 mg/kg or 0.06 mg/kg or lorazepam intramuscularly as preanaesthetic medication before the operation. The patients's self-assessments of degree of fatigue and apprehension were similar after each premedication when assessed before operation. Postoperative anxiety and confusion as well as need for postoperative care and supervision were greatest after 0.06mg/kg of lorazepam. Significantly (P smaller than 0.05 to P smaller than 0.01) fewer patients given 0.06 mg/kg or lorazepam remembered different events and procedures carried out on them before and after operation than those given other premedications, but no significant differences were noted in patients' ability to recall the performance of operation when asked on the following day. Seventy-seven, 63, and 57% of patients receiving 0.06 mg/kg of lorazepam remembered the start of blockade, performance of operation, and stay in recovery room, respectively. Intravenous sedation should be preferred to these intramuscularly administered premedications if drug-induced amnesia is sought to supplement local anaesthetic techniques.     

Efficacy of three doses of ketamine with bupivacaine for caudal analgesia in pediatric inguinal herniotomy

BACKGROUND AND OBJECTIVES: Ketamine administered systemically is a potent analgesic at subanesthetic plasma concentrations. Addition of ketamine to bupivacaine for caudal epidural block significantly prolongs the duration of postoperative analgesia. The purpose of this prospective, randomized double-blind study is to identify the optimal dose of ketamine that produces the maximum duration of caudal analgesia with minimal adverse effects as an adjuvant to bupivacaine for caudal epidural block. METHODS: Sixty children, aged 6 months to 10 years, undergoing inguinal herniotomy were allocated randomly to receive 1 of 3 solutions for caudal epidural block. Group 1 received 0.75 mL/kg of bupivacaine 0.25% with preservative-free ketamine 0.25 mg/kg, group 2 received 0.75 mL/kg of bupivacaine 0.25% with ketamine 0.5 mg/kg, and group 3 received 0.75 mL/kg of bupivacaine 0.25% with ketamine 1 mg/kg. Postoperative pain was assessed using the All India Institute of Medical Sciences pain discomfort scale. Rescue analgesia in the form of pethidine 1 mg/kg intramuscularly was administered when this score exceeded 4. RESULTS: The mean duration of caudal analgesia was 8.8 hours in group 1 compared with 22.1 hours in group 2 (P <.001) and 25.2 hours in group 3 (P <.001). Supplemental analgesia requirements with pethidine were significantly less in group 2 (4 subjects) and group 3 (no subject) when compared with group 1 (18 subjects). There were no differences between the groups in the incidence of motor blockade, urinary retention, emesis, or sedation. Group 3 had a significantly higher incidence of behavioral side effects such as odd behavior, agitation, or restlessness than groups 1 and 2. CONCLUSIONS: The optimal dose of ketamine in our study was 0.5 mg/kg added to 0.75 mL/kg bupivacaine 0.25% for caudal epidural block without an increase in side effects.     

Preinduction of anesthesia in children with rectally administered midazolam

The authors evaluated the efficacy of rectally administered midazolam for preinduction (i.e., premedication/induction) of anesthesia in 67 pediatric patients, ASA physical status 1 or 2, undergoing a variety of elective surgical procedures. In phase 1, 41 children weighing 12 +/- 3 kg (range 7-20 kg) and 31 +/- 16 months (range 8-67 months) of age (mean +/- SD) received midazolam, 0.4-5.0 mg.kg-1, in an attempt to produce unconsciousness. Only one child lost consciousness (4.5 mg.kg-1). However, at all doses, inhalational induction of anesthesia was facilitated because children were tranquil and calmly separated from their parent(s). There were no clinically significant changes in arterial blood pressure, heart rate, oxyhemoglobin saturation, and end-tidal carbon dioxide concentration, 10 min after drug administration. In phase 2, 26 children weighing 17 +/- 4 kg (range 10-26 kg) and 44 +/- 19 months (range 17-84 months) months of age undergoing tonsil and/or adenoid surgery were studied to determine the optimal sedative dose of rectally administered midazolam. Patients received 0.3, 1.0, 2.0, or 3.0 mg.kg-1 of midazolam in a randomized, double-blind fashion. One third (3 of 9) of patients receiving 0.3 mg.kg-1 struggled during mask induction. All patients receiving greater than or equal to 1.0 mg.kg-1 were adequately sedated (P less than 0.008). Discharge from the postanesthesia care unit (PACU), however, was delayed (greater than 60 min) in children receiving greater than or equal to 2.0 mg.kg-1 (P less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)     

Inclusion of pethidine in lidocaine for infiltration improves analgesia following tonsillectomy in children

Background: Previous work has demonstrated that pethidine exerts local anaesthetic effects on peripheral nerves in vivo. We examined the effects of infiltration anaesthesia by a combination of pethidine and lidocaine on post-tonsillectomy pain and restlessness in children.
Methods: Eighty children were randomly allocated to receive peritonsillar infiltration postoperatively with 3 ml of lidocaine 2% (1.5 ml on each side) combined with either 0.1 ml pethidine, 10 mg · ml^-1, (pethidine group) or 0.1 ml normal saline (control group). Pain and behaviour were assessed at 1, 3, 6 and 12 h postoperatively and on the following morning by the patients and by a nurse blinded to previous treatment.
Results: Patients in the pethidine group had lower pain scores than those in the control group at rest as well as swallowing during the whole observation period ( P < 0.05). Paracetamol was given to 34/40 children in the control group and to 6/40 children in the pethidine group. The corresponding figures for pethidine administration were 6/40 and 0/40, respectively. Patients in the pethidine group displayed a more rapid return to calm wakefulness than those in the control group ( P <0.01).
Conclusions: Inclusion of a low dose of pethidine in lidocaine for tonsillar infiltration improves pain relief after tonsillectomy in children.     

Comparison of methohexital and pentobarbital for premedication in children

Thirty children scheduled for elective orchiopexy or herniotomy were consecutively assigned at random to premedication with methohexital 80 mg/ml, 20 mg/kg rectally, 15 min before transportation to the operating room, or pentobarbital 28 mg/ml, 7 mg/kg rectally, 45 min before transportation. The quality of premedication was recorded at induction with halothane 1-2% and 60% N2O in O2 by mask. All patients received a caudal injection of bupivacaine 1.9 mg/ml, 1.25 ml/kg before surgery. Following completion of anaesthesia, the postoperative wake-up time and the duration of stay in the post-operative recovery room were recorded. The degree and quality of recovery were assessed using the Aldrete score every 30 min until discharge from the recovery room. The group of children receiving methohexital showed a highly significantly shorter awakening time, and a highly significantly shorter stay in the recovery room compared to the pentobarbital group. The children in both groups had a quiet, easy recovery without significant signs of confusion or agitation, and no difference in quality of recovery could be shown. Emergence delirium or agitation in connection with pentobarbital premedication and a possible relation to postoperative pain is discussed.     

Sublingual Buprenorphine for Premedication and Postoperative Pain Relief in Orthopaedic Surgery

The effect of sublingual buprenorphine (Temgesic) as a premedicant and for postoperative pain relief compared with morphine/pethidine was studied in 50 patients scheduled for elective surgery of the knee joint. Twenty-five patients received buprenorphine 0.4 mg sublingually 1 h before surgery and the same dose on demand postoperatively. Twenty-five patients were given morphine intramuscularly (7.5 mg or 10 mg to females and males respectively) 1 h preoperatively. This group received pethidine (75 mg) intramuscularly on demand postoperatively. All the patients were anaesthetized with halothane N2O/O2 after induction with thiopentone. No significant differences were found with regard to sedation, dizziness, nausea and vomiting during the study period. Emergence shivering, confusion and restlessness just after termination of the operation were equal in the two groups. In the recovery room, however, there was a higher frequency of shivering (P less than 0.05) in the morphine group. During the first 24 h postoperatively the buprenorphine group was given an average of 3.8 doses compared with 2.3 in the pethidine group (P greater than 0.05). It is concluded, that buprenorphine sublingually is as good as morphine intramuscularly for premedication and therefore should be recommended to patients who wish to avoid injections. For postoperative pain relief the initial dose of buprenorphine should be given intravenously. Only minor and unimportant side effects were seen.     

The Influence of Body Weight on Plasma Concentration of Atropine after Rectal Administration in Children

To avoid an unpleasant injection, the rectal administration of drugs to children is often to be preferred. Very little has been published on plasma concentrations of atropine given rectally. To determine whether body weight has any influence on the plasma concentrations of atropine, 18 children weighing 7.5-55.0 kg were given 0.02 mg atropine sulphate per kg rectally, and the plasma levels of atropine were determined. The mean peak plasma concentration of atropine was 1.17 ng/ml and it was reached after 33 min. In the group of smaller children (b.w. less than 15 kg) the peak plasma concentration was (0.83 ng/ml) lower than that observed in older children (1.26-1.36 ng/ml), but this difference was not statistically significant. Plasma concentrations in the group of smaller children declined significantly faster than in the other weight groups.     

COMPARATIVE PLASMA CONCENTRATION PROFILES AFTER I.V., I.M. AND RECTAL ADMINISTRATION OF PETHIDINE IN CHILDREN

Plasma concentration—time curves of pethidine and norpethidinewere studied in 25 children allocated after operation to threegroups to receive pethidine 1 mg kg^–1 i.v., i.m. or rectally.Peak concentrations occurred after 5± 1, 10 ±2, and 60 ± 10 min, respectively, while the maximum concentrationsamounted to 2800±462, 1609 ± 367 and 531 ±179nmol litre^–1, respectively. The area under the curve (0–240min) was similarly reduced in the group with rectal administration(P < 0.05). Compared with the i.v. data, approximately 40%systemic availability occurred after rectal application, althoughconsiderable individual variastion was noted. In one child veryhigh plasma concentrations were observed after rectal administration,possibly as a result of redistribution/recirculation phenomena.The average results are similar to those obtained when otheropioids are given rectally.     

The Influence of Intramuscularly Administered Pethidine on the Amnesic Effects of Intravenous Diazepam during Intravenous Regional Anaesthesia

Patients undergoing surgery under regional anaesthesia often receive narcotic analgesics for premedication which may modify the sedative and amnesic effects of intravenously administered diazepam. Sixty-two patients scheduled for upper extremity surgery under intravenous regional anaesthesia received 0.15 mg/kg of diazepam intravenously to supplement the local anaesthesia. Thirty-two of the patients received 0.01 mg/kg of atropine plus 1 mg/kg of pethidine and 30 patients only atropine intramuscularly approximately 1 h before the injection of diazepam. Another 30 patients received the same atropine-pethidine premedication and saline intravenously, and served as a reference group. Atropine-pethidine premedication followed by saline did not produce any amnesic effects. Sixty-nine and 38% of patients receiving atropine-pethidine premedication followed by diazepam did not remember a picture shown to them 15 min after diazepam injection or the performance of operation, respectively, the respective figures for patients given atropine premedication followed by diazepam being only 23% and 0% (P<0.01 - 0.001 between groups). The anti-recall of painful stimulus (exanguination) was significantly (P<0.01) more common when diazepam was given after pethidine premedication (31%) when compared to its injection after atropine alone (7 %). The drowsiness produced by the drugs was greatest and the overall patient acceptability of the technique used most satisfactory when pethidine was used for premedication and diazepam for sedation. It is concluded that intramuscularly administered pethidine potentiates the amnesic action of intravenous diazepam for painful stimuli, prolongs the amnesic action of diazepam for visual stimuli and improves the patients' acceptability of intravenous regional anaesthesia supplemented by intravenous diazepam.     

Reevaluation of rectal ketamine premedication in children: comparison with rectal midazolam

BACKGROUND: Results of previous studies of rectal ketamine as a pediatric premedication are clouded because of lack of dose-response relation, inappropriate time of assessing sedative effects, and previous administration or coadministration of benzodiazepines. Therefore, the authors reevaluated the efficacy of rectally administered ketamine in comparison with 1 mg/kg rectal midazolam. METHODS: Sixty-six infants and children (age, 7-61 months) who were American Society of Anesthesiologists physical status I and who were undergoing minor surgeries as in-patients were randomized to receive 5 mg/kg ketamine (n = 16), 7 mg/kg ketamine (n = 16), 10 mg/kg ketamine (n = 17), or 1 mg/kg midazolam (n = 17) via rectum. A blinded observer scored sedation 45 min and 15 min after administration of ketamine and midazolam, respectively, when children were separated from parent(s) for inhalational induction. All children underwent standardized general anesthesia with sevoflurane, nitrous oxide, and oxygen with endotracheal intubation. Blood pressure, heart rate, and oxyhemoglobin saturation were determined before, during, and after anesthesia. Postoperative recovery characteristics and incidence of adverse reactions were also assessed. RESULTS: Most children (88%) who received rectally 10 mg/kg ketamine or 1 mg/kg midazolam separated easily from their parents compared with those (31%) who received 7 or 5 mg/kg rectal ketamine (P < 0.05). Similarly, more children who received 10 mg/kg ketamine or 1 mg/kg midazolam underwent mask induction without struggling or crying compared with those who received 7 or 5 mg/kg ketamine (P < 0.05). There were no clinically significant changes in blood pressure, heart rate, and oxyhemoglobin saturation after administration of either drug. Immediately after surgery, more children receiving midazolam or 5 mg/kg ketamine were agitated compared with 7 or 10 mg/kg ketamine. Ketamine, 7 and 10 mg/kg, provided postoperative analgesia, but the largest dose of ketamine was associated with delayed emergence from general anesthesia. CONCLUSIONS: The results indicate that rectally administered ketamine alone produces dose-dependent sedative effects in children, when evaluated at its predicted peak plasma concentration. Ketamine, 10 mg/kg, has a delayed onset but is as effective as 1 mg/kg midazolam for sedating healthy children before general anesthesia. However, 10 mg/kg rectal ketamine is not recommended for brief surgeries because of prolonged postoperative sedation.     

Anaesthesia without tears.

Rectal induction of anaesthesia is a useful method but is not widely used in South Africa. We studied the onset of action and side-effects of 1% methohexitone administered rectally in a dose of 20 mg/kg to 110 preschool children. Ninety-one per cent were adequately sedated for inhalation induction by mask within 10 minutes, and all by 15 minutes, of drug administration. There was no evidence of significant cardiovascular or respiratory depression and only minor complications such as faecal soiling (11.8%) and hiccough (3.6%) were noted. The technique has been favourably received by parents, surgeons and nursing staff and has now become routine practice.     

Reevaluation of Rectal Ketamine Premedication in Children: Comparison with Rectal Midazolam

Background: Results of previous studies of rectal ketamine as a pediatric premedication are clouded because of lack of dose-response relation, inappropriate time of assessing sedative effects, and previous administration or coadministration of benzodiazepines. Therefore, the authors reevaluated the efficacy of rectally administered ketamine in comparison with 1 mg/kg rectal midazolam.

Methods: Sixty-six infants and children (age, 7-61 months) who were American Society of Anesthesiologists physical status I and who were undergoing minor surgeries as in-patients were randomized to receive 5 mg/kg ketamine (n = 16), 7 mg/kg ketamine (n = 16), 10 mg/kg ketamine (n = 17), or 1 mg/kg midazolam (n = 17) via rectum. A blinded observer scored sedation 45 min and 15 min after administration of ketamine and midazolam, respectively, when children were separated from parent(s) for inhalational induction. All children underwent standardized general anesthesia with sevoflurane, nitrous oxide, and oxygen with endotracheal intubation. Blood pressure, heart rate, and oxyhemoglobin saturation were determined before, during, and after anesthesia. Postoperative recovery characteristics and incidence of adverse reactions were also assessed.

Results: Most children (88%) who received rectally 10 mg/kg ketamine or 1 mg/kg midazolam separated easily from their parents compared with those (31%) who received 7 or 5 mg/kg rectal ketamine (P < 0.05). Similarly, more children who received 10 mg/kg ketamine or 1 mg/kg midazolam underwent mask induction without struggling or crying compared with those who received 7 or 5 mg/kg ketamine (P < 0.05). There were no clinically significant changes in blood pressure, heart rate, and oxyhemoglobin saturation after administration of either drug. Immediately after surgery, more children receiving midazolam or 5 mg/kg ketamine were agitated compared with 7 or 10 mg/kg ketamine. Ketamine, 7 and 10 mg/kg, provided postoperative analgesia, but the largest dose of ketamine was associated with delayed emergence from general anesthesia.     

Preanaesthetic Medication with Rectal Diazepam in Children

With the purpose of avoiding injections to children, the quality of rectal premedication with a solution of diazepam (Apozepam) was investigated in a double-blind study. Compared with a lytic cocktail (containing pethidine, promethazine and chlorpromazine), adequate preanaesthetic sedation was obtained with rectally administered diazepam in a dose of 0.75 mg kg^-1. However, following rectal diazepam, the majority of the children were very restless during recovery, but the combination of diazepam premedication and a small dose of lytic cocktail given i. m. during anaesthesia secured a smooth recovery in practically all children. The proportion of cases classified as "unsatisfactory" was higher in children below the age of 5 years than in the older children.     

The effect of rectal pH values on the absorption of methohexital

The factors underlying the unpredictability of the pharmacokinetics of rectally administered methohexitone remain unclear. The "pH partition hypothesis" offers an explanation. We investigated six children with rectal pH values ranging from 7.5 to 9.8, who were given 25 mg/kg methohexitone 10% via the rectal route under general anaesthesia. Blood samples were taken at zero, 3, 5, 7, 10, 15, 20, 30, 40, 60, 90 and 120 min; rectal pH was measured at zero and 1 min. The methohexitone plasma levels reached a maximum (Cmax) of 2.63 micrograms/ml (median) after 17.5 min (median). The elimination half-life ranged from 37 to 218 min. No positive correlation between lower pH and better resorption (AUC and Cmax) was found. The resorption kinetics of rectally administered methohexitone cannot be explained by its electrochemical properties alone.     

Intramuscular ketamine analgesia in emergency patients. II. Clinical study of traumatized patients

Twenty traumatized patients suffering from burns, fractures and bruises were given either 0.5 mg/kg or 1.0 mg/kg ketamine intramuscularly for analgesia. Within 10 min effective analgesia was present in both groups. In the 1 mg/kg group analgesia was more intense, and of longer duration. The higher dose of ketamine led to an impairment in the level of consciousness. Some of the patients of this group were markedly desorientated. The highest plasma levels of ketamine were 147 ng/ml (median) in the 0.5 mg/kg group at 30 min and 474 ng/ml (median) in the 1.0 mg/kg group at 15 min. As to side-effects, 3 patients reported dizziness and 1 patient vomited. Intramuscular applications of 0.5 mg/kg ketamine affords a good but short lasting analgesia with few side-effects.     

Pharmacokinetic studies following intravenous and rectal administration of midazolam in children

In children, rectal midazolam is being used increasingly for premedication, as this substance is reported to have a short half-life and rapid action. Above all it is the only known diazepam derivative with a good correlation of plasma concentration and clinical action despite its receptor binding capacity. As pharmacokinetic data in children are lacking and different dose regimens for rectal premedication exist, we studied plasma concentrations in 3 groups of children. METHODS. After obtaining informed parental consent we studied children aged 3-7 years (15-30 kg body weight) ASA I status scheduled for minor elective surgery. Group 1 (n = 6) received 0.1 mg/kg midazolam i.v. for induction of anesthesia. Group 2 (n = 10) was premedicated with 0.35 mg/kg midazolam, instilled just behind the anal sphincter; group 3 (n = 5) received 0.5 mg/kg midazolam rectally. Blood samples were drawn up to 120 min after application. The anesthesia technique consisted of N2O/O2, enflurane, intubation and the use of muscle relaxants, if necessary. Midazolam plasma levels were measured by HPLC. RESULTS. There were no differences with respect to age or body weight. Group 1: half-life in children was shorter than in adults, Vdss was smaller and clearance identical. Group 2: Rectal midazolam 0.35 mg/kg has a remarkably short onset of action with peak plasma concentrations (71 ng/ml) in the range of sedative levels in adults occurring in 7.5 min. After 2 h they reached levels of 30 ng/ml. Group 3 patients had peak levels of midazolam of 246 ng/ml after 12.5 min, falling to an average concentration of 120 ng/ml after 2 h. The bioavailability of rectal midazolam, comparing the area under the median curves, is 4.7% in group 2 and 16.1% in group 3. CONCLUSIONS: The pharmacokinetics of midazolam in our patients showed a shorter half-life, probably due to the higher hepatic clearance based on the high CI in children, as midazolam is known to have a first-pass effect of 30-70%. The increased metabolic transformation and the smaller amount of fatty tissue accounts for the smaller Vdss in children compared to adults. Rectal midazolam has a remarkably short onset and especially in a dose of 0.5 mg/kg prolonged action due to ongoing resorption from the rectum as demonstrated by the clinically relevant plasma concentrations. This fact must be taken into consideration in the overall anesthesia management.(ABSTRACT TRUNCATED AT 400 WORDS)     

Peritonsillar infiltration with bupivacaine and pethidine for relief of post-tonsillectomy pain: a randomised double-blind study

Previous studies of infiltration of local anaesthetics in children undergoing tonsillectomy resulted in conflicting results. The aim of this study was to evaluate the effect of the peritonsillar injection of bupivacaine and pethidine on postoperative pain in children undergoing snare-dissection tonsillectomy. In a double-blind study, 80 children (aged 7–15 years) were randomly divided into two groups receiving peritonsillar injection of either bupivacaine (1 mg.kg⁻¹) and pethidine (1 mg.kg⁻¹) in adrenaline 1 : 200 000 (treatment group) or an equivalent volume of saline (placebo group) pre-operatively. The time needed for first demand of analgesia and analgesic consumption to reduce the visual analogue scale (VAS) for resting throat pain to≤30, the VAS for pain on swallowing, drinking liquid and eating a soft diet, incidence of nausea and vomiting, and the need for rescue anti-emetics in the first 24 h after operation were compared in both groups. The combination of bupivacaine and pethidine could significantly decrease the consumption of analgesics for resting pain at 4, 6, 8, 12, and 24 h after operation but did not reduce pain on swallowing, drinking liquid and eating a soft diet. The times to demand of first dose of analgesic and to first oral intake were not significantly different. The overall satisfaction of patients in relation to relief of postoperative pain was not significantly different between the two groups. Although peritonsillar injection of pethidine and bupivacaine in children reduces the analgesic consumption, it does not affect the dynamic pain state in the first 24 h after snare-dissection tonsillectomy.     

Patient-controlled pethidine after major upper abdominal surgery: comparison of the epidural and intravenous routes.

We compared epidural (n = 17) and intravenous (n = 20) patient-controlled analgesia (PCA) using pethidine (bolus 10 mg, lockout interval 10 min, 4-h maximum dose 3 mg.kg(-1)) after total gastrectomy. We found that mean (SD) pethidine consumption in the first 24 h was 33% less in the epidural group [255 (85) mg] than in the intravenous group [379 (129) mg, p = 0.002], although most of this difference occurred in the first 8 h. Plasma concentrations of pethidine were lower at 8 h (p < 0.01) in the epidural group, but were similar at 24 h. Pain scores, side-effects, patient satisfaction and patient outcome were similar between groups. Epidural and intravenous pethidine PCA provided similar efficacy after major abdominal surgery, although the epidural route can reduce the amount of pethidine used initially.