腰硬联合麻醉剖宫产术后应用盐酸羟考酮联合超声引导罗哌卡因腹横肌平面阻滞的镇痛效果

目的探讨腰硬联合麻醉剖宫产术后应用盐酸羟考酮联合超声引导罗哌卡因腹横肌平面阻滞(TAPB)的镇痛效果。方法选取2018-12-2019-12间在兰考县中心医院接受腰硬联合麻醉剖宫产术的96例产妇。依据术后镇痛方法不同分为2组,各48例。对照组术毕时通过硬外导管注射盐酸羟考酮镇痛,观察组在对照组基础上联合罗哌卡因TAPB镇痛。比较2组的镇痛效果和舒适度。结果 2组不良反应发生率差异无统计学意义(P>0.05)。但各时点的NRS疼痛评分和舒适度BCS评分均显著优于对照组,差异有统计学意义(P<0.05)。结论对接受腰硬联合麻醉剖宫产的产妇,术后应用盐酸羟考酮联合罗哌卡因TAPB镇痛,未增加不良反应,有利于提升镇痛效果和产妇的舒适度。     

地塞米松复合罗哌卡因腹横肌平面阻滞在结肠癌术后镇痛中的效果观察

目的：观察地塞米松复合罗哌卡因腹横肌平面阻滞（TAPB）在结肠癌根治术后镇痛中的效果。方法：2017年9月—2021年9月安徽省阜阳市肿瘤医院收治行腹腔镜结肠癌根治术患者92例,随机分为两组,均于麻醉诱导后、手术开始前实施双侧TAPB,对照组TAPB药物为罗哌卡因（0.25%）,观察组为地塞米松和罗哌卡因（0.25%）混合液,术后均给予静脉自控镇痛（PCIA）,比较两组镇痛效果、炎性因子水平及不良事件发生率。结果：两组术后疼痛程度的视觉模拟评分（VAS评分）均先升高后下降,且观察组均低于对照组（P <0.01）;观察组舒芬太尼使用剂量、PCIA使用次数更少,PCIA首次使用时间更长（P <0.01）;两组术后各时间点肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平均更高（P <0.05）,但观察组低于对照组（P <0.01）;观察组不良事件发生率较对照组低（P <0.05）。结论：腹腔镜结肠癌根治术患者采用地塞米松复合罗哌卡因TAPB镇痛效果好,麻醉药物用量减少,炎症反应轻微,不良事件发生率较少。     

腹式子宫切除术后甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外病人自控镇痛的比较

目的比较腹式子宫切除术后甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外病人自控镇痛(PCEA)的效果。方法44例腹式子宫切除术病人随机分为两组(n=22):对照组应用0.75%盐酸罗哌卡因连续硬膜外麻醉,术后应用0.2%盐酸罗哌卡因作PCEA;试验组应用0.894%甲磺酸罗哌卡因连续硬膜外麻醉,术后应用0.237%甲磺酸罗哌卡因作PCEA。采用视觉模拟评分法(VAS)评价病人静卧时与咳嗽时的疼痛程度,以修正的Bromage评分法评价病人运动阻滞程度,记录镇痛质量、PCEA 情况和不良反应发生情况。结果两组病人术后VAS评分、镇痛质量、运动阻滞程度及不良反应的发生率比较差异无统计学意义(P>0.05),试验组镇痛泵有效按压次数少于对照组(P<0.05),除PCEA开始-4 h外,试验组病人其余时间段用药量均少于对照组(P<0.05)。结论0.237%甲磺酸罗哌卡因可用于腹式子宫切除术后PCEA,其镇痛效果和安全性与0.2%盐酸罗哌卡因相似。     

罗哌卡因与布比卡因混合液在混合痔切除术中的麻醉效果

目的:比较两种药物行肛周局部浸润麻醉在混合痔切除术的效果。方法:将行局部浸润麻醉的混合痔切除术350例患者随机分为罗哌卡因组(A组)和布比卡因混合液组(B组),分别给予0.375%罗哌卡因和布比卡因混合液行局部麻醉。结果:两组麻醉药的起效时间无明显差异(P0.05),A组麻醉持续时间明显长于B组(P0.01);术中低血压、心动过缓发生率低于B组(P0.05或P0.01),术后第2、4、6h疼痛评分显著低于B组(P0.01)。结论:用罗哌卡因行肛周局部浸润麻醉在混合痔切除术中的麻醉效果可靠,术后镇痛作用好,术中不良反应小。     

右美托咪定复合罗哌卡因腹横肌平面阻滞对老年患者结直肠癌根治术后早期恢复质量的影响

目的探讨右美托咪定复合罗哌卡因腹横肌平面阻滞(TAPB)对老年结直肠癌根治术患者术后早期恢复质量的影响。方法择期全麻下行腹腔镜下结直肠癌根治术患者60例,男33例,女27例,年龄65~85岁,BMI 19~25kg/m^2,ASAⅡ或Ⅲ级,采用随机数字表法分为罗哌卡因组(C组)和右美托咪定复合罗哌卡因组(D组),每组30例。两组于麻醉诱导前在超声引导下行双侧TAPB,C组给予0.375%罗哌卡因,每侧20 ml;D组给予0.375%罗哌卡因+右美托咪定0.5μg/kg,每侧20 ml。术后连接自控静脉镇痛泵(吗啡50 mg稀释至50 ml)作为补救镇痛,PCA剂量1 ml,锁定时间5 min,无背景输注。分别于术前1 d及术后3 d进行40项恢复质量(QoR-40)及匹兹堡睡眠质量指数(PSQI)评分。记录术后首次补救镇痛时间、吗啡消耗量及不良反应的发生情况。结果与C组比较,D组术后3 d QoR-40量表评分中身体舒适度、情绪状态、心理支持、疼痛及总评分明显升高,PSQI评分和吗啡消耗量明显降低,术后首次补救镇痛时间明显延长(P<0.05)。两组术后不良反应发生率差异无统计学意义。结论右美托咪定复合罗哌卡因腹横肌平面阻滞可有效提高老年结直肠癌根治术患者术后早期睡眠及恢复质量,有利于老年患者术后康复。     

不同容积布比卡因腹横肌平面阻滞用于腹股沟斜疝患儿术后镇痛的效果

目的探讨使用相同浓度不同容积的布比卡因行腹横肌平面阻滞对患儿腹股沟斜疝患儿术后镇痛作用的影响。方法择期行腹股沟斜疝修补术的患儿120例,男95例,女25例,年龄1～6岁,体重8.3～26.5 kg,ASAⅠ级。随机分为四组,三组使用浓度为0.15%的布比卡因,按不同容积分为0.4 ml/kg组(V4组)、0.5 ml/kg组(V5组)、0.6 ml/kg组(V6组);一组使用2%的利多卡因进行局部浸润麻醉(V0组)。采用儿童疼痛行为量表评估术后即刻(T_0)和术后1 h(T_1)、2 h(T_2)、6 h(T_3)的疼痛程度。当儿童疼痛行为量表评分5分时,静脉注射芬太尼0.25μg/kg补救镇痛。记录术后1 h追加芬太尼的例数。结果与V6组比较,T_2—T_3时V4、V5、V0组儿童疼痛行为量表评分明显升高(P0.05);与T_0时比较,T_2—T_3时V4、V5、V0组儿童疼痛行为量表评分明显增高(P0.05),T_3时V6组儿童疼痛行为量表评分明显增高(P0.05)。与V0组比较,V6组术后1 h内追加芬太尼的例数明显减少(P0.05)。结论儿童患者腹股沟疝修补术使用0.15%布比卡因行TAPB时,在有效剂量和安全剂量范围内,布比卡因的容积更大,术后1 h内镇痛不足的比例减少,术后6 h内镇痛作用持续时间较长,镇痛效果更好。     

超声引导下外侧弓状韧带上腰方肌前路阻滞与腹横肌平面阻滞在子宫切除术中的比较北大核心CSCD

目的评价超声引导下外侧弓状韧带上腰方肌前路阻滞(QLB-LSAL)和腹横肌平面阻滞(TAPB)对开腹子宫切除术患者镇痛效果及术后康复情况的影响。方法选择择期开腹子宫切除术患者60例,年龄35~64岁,BMI 21~29 kg/m^(2),ASAⅠ或Ⅱ级。随机分为两组:QLB-LSAL组(Q组)和TAPB组(T组),每组30例。麻醉诱导前,Q组在超声引导下行双侧QLB-LSAL,T组在超声引导下行双侧TAPB,两组每侧均给予0.375%罗哌卡因20 ml。术毕两组均行患者自控静脉镇痛(PCIA)。记录阻滞后5 min、6、24、48 h的阻滞平面节段,阻滞后6、24、48 h静息和活动时VAS疼痛评分和阻滞后48 h静息时VAS疼痛评分大于4分的发生情况,术后48 h舒芬太尼用量、镇痛泵按压次数和补救镇痛情况,下床活动时间、首次肛门排气时间、术后进食时间、术后住院时间,术后皮肤瘙痒、恶心呕吐等不良反应发生情况。结果阻滞后5 min、6、24、48 h Q组阻滞平面节段明显多于T组(P<0.05)。阻滞后6、24、48 h两组静息和活动时VAS疼痛评分差异无统计学意义,阻滞后48 h时,两组静息时VAS疼痛评分>4分发生率差异无统计学意义。术后48 h内Q组舒芬太尼用量、镇痛泵按压次数明显少于T组(P<0.05),补救镇痛率明显低于T组(P<0.05)。Q组首次下床活动时间、首次肛门排气时间和术后住院时间明显短于T组(P<0.05)。两组术后皮肤瘙痒、恶心呕吐发生率差异无统计学意义。结论与腹横肌平面阻滞比较,超声引导下外侧弓状韧带上腰方肌前路阻滞能有效缓解开腹子宫切除术患者术后疼痛,减少术后镇痛药物用量,术后恢复更快。     

静脉自控镇痛联合腹横肌平面阻滞在结直肠癌患者术后镇痛中的应用

目的采用随机对照方法研究静脉自控镇痛(Patient-controlled intravenous analgesia,PCIA)联合腹横肌平面阻滞(Transverses abdominis plane block,TAPB)对腹腔镜直肠癌根治术患者术后镇痛效果。方法选择腹腔镜直肠癌根治术病人随机分为PCIA联合TAPB组作为观察组;PCIA组作为对照组,两组均为52例。观察组在气管插管全麻后行超声引导下以0.25%罗哌卡因行双侧腹横肌平面阻滞,术毕双侧再给予0.25%罗哌卡因各20ml。对照组在术后给予PCIA(舒芬太尼150μg+150ml生理盐水)。统计两组病人术后下床活动时间、肛门排气时间、术后(4、8、24小时)VAS评分、PCIA触发次数。结果两组病人在性别、年龄、术前ASA评分方面差异无统计学意义(P0.05)。观察组与对照组比较:术后下床活动时间、肛门排气时间均减少;术后(4、8、24小时)VAS分、PCIA触发次数均降低,差异有统计学意义(P0.05)。结论 PCIA联合TAPB对于腹腔镜直肠癌病人术后镇痛效果优于PCIA单用,有利于病人术后早期下床活动及肠功能恢复。     

切口疝修补术中在补片与腹膜间注射盐酸布比卡因的效果分析

目的评价腹腔镜腹壁切口疝修补术(LVHR)中在补片和腹膜之间注射长效局麻药布比卡因对术后早期疼痛与镇痛药使用剂量的影响。方法选取2015年8月至2016年8月在惠州市第三人民医院接受LVHR术的患者80例,随机分为布比卡因组与对照组,布比卡因组患者在LVHR术中于补片和腹膜间注射0.5%盐酸布比卡因注射液1 ml/cm2,对照组患者在术中注射相同剂量的氯化钠溶液。观察并比较患者在麻醉恢复室与返回病房后的疼痛程度、静脉及口服镇痛药物使用剂量和术后至正常进食及行走的时间。结果布比卡因组患者麻醉恢复室内的平均疼痛评分显著低于对照组(P=0.015),返回病房后第一个2 h内布比卡因组患者的疼痛评分显著低于对照组(P=0.003);2组患者在返回病房第一个2 h后各时间段内疼痛评分差异无统计学意义(P0.05);2组患者术后至正常饮食及行走时间差异无统计学意义(P0.05);布比卡因组患者术后4 h内及总静脉麻醉药物用量显著低于对照组(P=0.000),2组患者术后总口服止痛药量差异无统计学意义(P=0.885)。结论 LVHR术中在补片与腹膜之间注射长效局麻药布比卡因可以显著减轻术后早期疼痛程度和减少静脉镇痛药物用量。     

氢吗啡酮联合罗哌卡因超声引导腹横肌平面阻滞在腰硬联合麻醉剖宫产术后镇痛效果观察

目的探讨剖宫产术后使用硬膜外单次注射盐酸氢吗啡酮联合超声引导腹横肌平面阻滞(TAPB)的镇痛效果。方法随机将2018-01—2019-01间于惠州市中心人民医院行腰硬联合麻醉下子宫下段剖宫产术的90例产妇分为3组。在手术完成、拔出硬膜外导管前,Ⅰ组采用硬膜外单次注射盐酸氢吗啡酮镇痛,Ⅱ组应用TAPB镇痛,Ⅲ组行硬膜外单次注射盐酸氢吗啡酮联合TAPB镇痛。比较3组产妇术后3 h、6 h、12 h、24 h、48 h静息状态下切口和宫缩VAS疼痛评分及BCS舒适评分。观察3组产妇的不良反应。结果 3组产妇切口VAS疼痛评分均呈现先上升后下降趋势,24 h到达峰值。Ⅲ组产妇各时段的VAS疼痛评分均显著低于Ⅰ组和Ⅱ组,差异有统计学意义(P0.05)。Ⅰ组和Ⅲ组产妇术后各时间段宫缩痛VAS评分均优于Ⅱ组,差异有统计学意义(P0.05))。Ⅰ组与Ⅲ组术后3 h、6 h、12 h宫缩痛VAS评分差异无统计学意义(P0.05),但Ⅲ组产妇术后24 h和48 h宫缩痛VAS评分均显著低于Ⅰ组,差异有统计学意义(P0.05)。Ⅲ组产妇各时段BCS评分均显著优于Ⅰ组和Ⅱ组,差异有统计学意义(P0.05)。3组产妇不良反应的发生率差异无统计学意义(P0.05)。结论对接受腰硬联合麻醉剖宫产的产妇术后实施硬膜外单次注射盐酸氢吗啡酮联合TAPB镇痛,效果可靠,并能提高其舒适度,且不良反应无明显增加。     

The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy

The objective of our study was to see if incisional and intraperitoneal bupivacaine with epinephrine produces analgesia after total abdominal hysterectomy. Forty-six ASA physical status I and II patients received a standardized anesthetic, patient-controlled analgesia (PCA) morphine, and rectal paracetamol 1 g every 6 h. Patients were randomized to receive 50 mL of bupivacaine 0.25% with epinephrine 5 microg/mL or 50 mL of normal saline. Thirty milliliters and 20 mL of treatment solution were administered into the peritoneum and incision, respectively, before wound closure. Seventeen and 16 patients in the Placebo and Bupivacaine groups, respectively, completed the study. The reasons for withdrawal were PCA malfunction, PCA discontinued too early, nausea, chest infection, intraabdominal drain insertion, and protocol violation. There were no significant differences between the Bupivacaine and Placebo groups in age, height, weight, or duration of surgery. Pain on movement was significantly more intense in the Placebo group than in the Bupivacaine group on awakening. Morphine consumption (interquartile range) over 24 h was 62 mg (53-85 mg) in the Placebo group compared with 44 mg (33-56 mg) in the Bupivacaine group (P < 0.01). This significant difference was attributable to the larger morphine consumption in the Placebo group in the first 4 postoperative h. We conclude that a combination of intraperitoneal and incisional bupivacaine with epinephrine provides significant morphine-sparing analgesia for 4 h after total abdominal hysterectomy. IMPLICATIONS: A combination of intraperitoneal and incisional bupivacaine with epinephrine may be recommended because it provides significant morphine-sparing analgesia for 4 h after total abdominal hysterectomy.     

Does pre-incisional thoracic extradural block combined with diclofenac reduce postoperative pain after abdominal hysterectomy?

In a double-blind, randomized study, we investigated 40 patients undergoing abdominal hysterectomy; patients received 0.5% plain bupivacaine 20 ml via a low thoracic extradural catheter and a diclofenac suppository (100 mg), either 30 min before incision (group 1) or 30 min after incision (group 2). All patients received a standard general anaesthetic and no opioid was used before or during operation. Postoperative analgesic requirements were measured using a patient- controlled analgesia (PCA) system. Pain was assessed using a visual analogue scale (VAS) and a verbal pain score (VPS) on movement up to 48 h after operation. There was no significant difference in the time to first request for morphine but consumption of morphine was significantly greater in group 1 at all times except 24 h. There were no significant differences in VAS and VPS pain scores, although both scores were consistently higher in group 1. Patient satisfaction with the quality of analgesia, at 24 h, demonstrated no significant difference between the two groups. The combination of extradural block and diclofenac suppository given before operation did not appear to produce a clinically effective pre-emptive analgesic effect.      

A randomized, double-blind comparison of the effects of interpleural bupivacaine and saline on morphine requirements and pulmonary function after cholecystectomy

The effect of interpleural bupivacaine and saline placebo on morphine requirements and pulmonary function after cholecystectomy was investigated. Twenty-six patients were randomly assigned on postoperative day 1 to receive either 20 ml preservative-free saline (group 1) or 20 ml 0.5% bupivacaine with epinephrine, 5 micrograms/ml (group 2) through an interpleural catheter. Adequacy of pain relief was determined by the amount of morphine used by the patient following interpleural injection. Morphine use via a patient-controlled analgesia (PCA) system was recorded for several hours before and after interpleural injection. All patients had a forced vital capacity (FVC) and FEV1 measurement immediately before and 1 h after interpleural injection. Mean hourly PCA morphine use ranged from 1.6 to 2.8 mg for the 6 h prior to interpleural treatment for groups 1 and 2. There was no difference in PCA use between the groups during this time. Group 1 patients did not reduce PCA morphine use after interpleural saline. Patients in group 2, however, significantly reduced PCA morphine use after interpleural bupivacaine. Mean PCA morphine use for group 2 was 0.38 +/- 0.15 mg/h (mean +/- SE) (81% reduction vs. control) for the first 2 h after bupivacaine (P less than 0.05). Mean PCA use in group 2 was 0.52 +/- 0.2 mg/h (73% reduction vs. control) for the third hour after bupivacaine (P less than 0.05). At the fourth and fifth hours after bupivacaine injection, mean PCA morphine use was not significantly different from that in group 1. FVC and FEV1 did not improve after interpleural saline.(ABSTRACT TRUNCATED AT 250 WORDS)     

Wound infiltration with local anaesthetic after abdominal hysterectomy

The study was performed to investigate if wound infiltration with 20 ml of 0.5% bupivacaine after abdominal hysterectomy improved analgesia and reduced morphine requirements from a patient-controlled analgesia system during the first 6 h after operation. Forty patients undergoing abdominal hysterectomy were allocated randomly to one of two groups. The study was performed in a double-blind controlled manner. Morphine requirements in the first 6 h after operation were similar in both the control (30.3 mg) and bupivacaine (29.0 mg) groups. Cumulative hourly morphine requirements did not differ significantly between the two groups. Pain scores assessed by visual analogue were similar in both groups.      

Epidural ketamine reduces post-operative epidural PCA consumption of fentanyl/bupivacaine

Purpose

To study the analgesic effect of epidural ketamine on postoperative pan and epidural PCA consumption after total abdominal hysterectomy.

Methods

Sixty-one ASA I–II patients, 34–60 yr were randomly assigned into three groups. Epidural catheters were inserted before induction of anaesthesia. Patients in group I and II received 30 mg ketamine epidurally before induction of anaesthesia or 20 min after skin incision: group III received placebo, Postoperatively, on first analgesia request, sedation score, Visual Analogue Scale (VAS), Prince Henry Score (PHS) and Bromage motor weakness score were taken and followed by an epidural bolus of 9 ml bupivacaine 0.25% + 50 μg fentanyl. Analgesia was maintained by PCA with a mixture of bupivacaine 0.1% + fentanyl 0.001% epidurally. Measurements were repeated at 1, 2, 4, 8, 12 and 24 hr.

Results

First analgesia request was 17 ±6.8 min in the control group compared with 31.4 ±23.8 and 44 ±23.1 min for groups I and II respectively. The differences between group III and group I (P < 0.05) and between group III and group II (P < 0,01) were statistically significant. Twenty four hour PCA consumption was 101.2 ±47.2, 87 ±27 and 162 ±38 ml for groups I, II and III respectively. The differences between group III and group I and that between group III and group II were statistically significant (P < 0.001 ).

Conclusion

Epidural ketamine 30 mg reduces post hysterectomy pain as evidenced by prolongation of time to first analgesia request and reduction in postoperative epidural PCA consumption. This effect is manifest whether ketamine is given before induction or 20 min after skin incision.     

蛛网膜下腔注射吗啡或吗啡复合可乐定用于前列腺癌根治手术后镇痛的有效性研究

背景在此项随机研究中,我们比较了行耻骨后前列腺癌根治术的患者手术后采用蛛网膜下腔（IT）注射吗啡或吗啡复合可乐定镇痛与静脉自控吗啡镇痛（PCA）的疗效。方法将50例患者随机分为蛛网膜下腔注射吗啡组（4μg／kg）（M组）、蛛网膜下腔注射吗啡复合可乐定组（1μg／kg）（MC组）及PCA组。每例患者都使用PCA吗啡进行手术后镇痛。首要的观察指标是手术后48小时内吗啡的用量。同时记录首次使用自控吗啡镇痛的时间、静息痛和咳嗽时的疼痛评分、气管内导管拔管时间和副作用（瘙痒、手术后恶心呕吐、呼吸抑制）。结果M组和MC组的48小时内吗啡用量较少,M组的静息痛和咳嗽时的疼痛评分降低并持续到手术后18小时,而MC组则可持续到手术后24小时。并且这两组第1次需要PCA镇痛的时间延迟。手术中MC组舒芬太尼的需求量明显减少。结论蛛网膜下腔注射吗啡镇痛可以显著减少前列腺癌根治术后48小时内的吗啡用量。蛛网膜下腔注射吗啡复合可乐定可以减少手术中舒芬太尼的用量,延后患者需要PCA镇痛的时间,还能延长对静息痛和咳嗽时疼痛的镇痛时间。     

Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy

We have compared pain scores at rest and on standardized movement, and morphine consumption using patient-controlled analgesia in 60 patients who had undergone total abdominal hysterectomy. Patients were allocated randomly to one of three groups: in the saline group, 0.9% sodium chloride 50 ml was administered into the pelvic cavity before closure of the peritoneum; in the second group, the solution administered was 20 ml of 0.5% bupivacaine solution with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml; in the third group, the solution used was 20 ml [corrected] of 2% lidocaine with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml. We found that there was no significant difference between the three groups in visual analogue pain scores at 8, 12, 36 or 48 h after operation at rest or on movement, and no significant difference in sedation or dose of antiemetic administered. Mean morphine consumption in the first 24 h was 54.6 (SEM 5.9) mg in the saline group, 55.5 (6.4) mg in the bupivacaine group and 52.5 (5.3) mg in the lidocaine group. In the second 24 h, morphine consumption was 34.9 (6.6) mg, 28.1 (3.5) mg and 28.0 (3.5) mg in the three groups, respectively. We conclude that i.p. administration of local anaesthetic solution into the pelvic cavity did not confer appreciable analgesia in patients undergoing abdominal hysterectomy.      

The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy

To assess the effect of local anesthetic wound instillation on visceral and somatic pain, we studied 36 patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy. A standard general anesthetic was administered. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia such that the tip was at the midpoint of the surgical wound. After surgery, either bupivacaine 0.25% (Bupivacaine group) or sterile water (Control group) was administered via a patient-controlled analgesia device programmed to deliver 9.0 mL with a 60-min lockout interval. During the first 6 h after surgery, rescue IV morphine (2 mg) was administered every 10 min until a visual analog scale score of <30 mm was achieved. Thereafter, on patient request, rescue meperidine 1 mg/kg IM was administered. When compared with the Control group, significantly (P < 0.001) less rescue analgesia was administered to patients in the Bupivacaine group. Rescue morphine administered during the first 6 h after surgery was 6 +/- 4 mg versus 12 +/- 6 mg (P < 0.001) for the Bupivacaine and Control groups, respectively. Rescue meperidine administered was 29 +/- 37 mg versus 95 +/- 36 mg (P < 0.001) for the Bupivacaine and Control groups, respectively. Nausea and antiemetic drug administration was significantly (P = 0.003) less in the Bupivacaine group. Pain scores were similar between the groups. Patient satisfaction was significantly (P = 0.04) more in the Bupivacaine group. We conclude that bupivacaine wound instillation decreases opioid requirements and nausea in the first 24 h after total abdominal hysterectomy with bilateral salpingo-oophorectomy. IMPLICATIONS: Bupivacaine instillation via an electronic patient-controlled analgesia device provides effective analgesia after total abdominal hysterectomy with bilateral salpingo-oophorectomy.     

Thoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery

Twenty–one ASA I or II patients undergoing upper abdominal surgery were studied for 24 hours after operation. They were entered into a prospective, randomised study of patient–controlled intravenous morphine compared with continuous thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief was superior in the bupivacaine series ( P < 0.05) throughout the 24 hour study period and this was associated with significantly greater pulmonary ventilation compared with the PCA series. Forced expiratory parameters were reduced in both series after the operation but significantly less so in the epidural group. There was a reduced incidence of emetic symptoms in the epidural group ( P < 0.05) but the incidence of other minor side effects did not differ significantly. Thoracic epidural fentanyl/bupivacaine results in significantly better analgesia than patient–controlled intravenous morphine.     

Influence of droperidol on nausea and vomiting during patient-controlled analgesia

We have studied the addition of droperidol to morphine duringpatient-controlled analgesia (PCA) in 57 patients using PCAafter abdominal hysterectomy. Patients in group 1 (control group)received placebo at induction of anaesthesia and a PCA containingmorphine; those in group 2 received droperidol 1.25 mg and aPCA containing morphine and those in group 3 droperidol anda PCA containing droperidol 0.05 mg mg^–1 of morphine.Patients in the control group suffered 51 episodes of nauseacompared with 35 in the droperidol bolus group and 18 in thedroperidol PCA group (P < 0.01). In the droperidol PCA group,only 10 doses of additional antiemetic therapy were requiredcompared with 24 in the droperidol bolus group and 28 in thecontrol group (P < 0.05). We did not observe side effectsattributable to droperidol. We conclude that droperidol addedto morphine in PCA reduces nausea and antiemetic requirementsafter abdominal hysterectomy (Br. J. Anaesth. 1994; 72: 460–461)