Objective To investigate the efficacy of applying 10 ml bupivacaine 0.5 % versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia.Design Randomised, parallel, double-blind controlled trial.Setting Day Surgery Unit.
SubjectsMain outcome measures Time to first post-operative analgesia, and pain levels at 1 h, at discharge, and at time of first analgesia.
SummaryThis prospective, double-blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient-controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter 'Infusor' patient-controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to thejirst use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during thejirst 12 h after operation.
Key wordsPain; postoperative. Vomiting; antiemetics, droperidol.Patient-controlled analgesia (PCA) is an effective and increasingly popular method of providing postoperative analgesia, with advantages for the patient and for medical and nursing staff. However, nausea is reported to be a relatively common side effect, its incidence being similar to that seen with conventional intramuscular analgesia [I].When prescribing postoperative analgesia, it is common clinical practice to prescribe, in addition, antiemetic drugs as required, usually given intramuscularly or orally. However, there are potential drawbacks to both of these routes: intramuscular injections are painful and there is often an inevitable delay between need and administration, whilst oral antiemetics may not be absorbed and hence ineffective. It would therefore seem preferable to utilise the intravenous route which will exist if PCA is being employed. The use of antiemetic agents given with opioid analgesia might also have a prophylactic antiemetic effect. Droperidol has been shown to be an effective antiemetic agent in a number of clinical situations [2-4]. The present study was designed to assess the effectiveness of droperidol, given in conjunction with morphine PCA in reducing postoperative nausea and vomiting.
MethodThis double-blind, randomised, prospective, placebocontrolled study was approved by the hospital ethics committee. Patients presenting for lumbar laminectomy were approached by the investigators to assess their suitability and consent for inclusion in the study. Patients who were pregnant, had a hiatus hernia or a clinical history that would suggest a significant risk of acid reflux were not studied. Any history of motion sickness or previous postoperative nausea and vomiting was noted. Patients giving informed consent were instructed in the use of a Baxter 'Infusor' PCA device and educated in the use of the pain and nausea scoring scales. A 10-point pain scale and a 5-point nausea scale were used in this study (Fig. 1). These scales were chosen because they were routinely in use on the neurosurgical wards and were therefore familiar to the nursing staff. The nursing staff were also instructe...
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