SummaryWe have investigated the addition of adrenaline to pethidine for patient-controlled epidural analgesia after elective Caesarean section. In a randomised, double-blind study, patients received patient-controlled epidural analgesia for 24 h using pethidine 5 mg.ml -1 with adrenaline 5 mg.ml -1 (adrenaline group, n 40) or pethidine 5 mg.ml -1 without adrenaline (plain group, n 38). Visual analogue scale pain scores at rest and on coughing measured 2 h, 6 h and 24 h after surgery were similar between the two groups. There was a trend towards lower mean total consumption of pethidine in the adrenaline group (231.5 mg; SD 140.5 mg) compared with the plain group (289.5 mg; SD 139.5 mg; p 0.071). Patients in the adrenaline group had higher visual analogue scale scores for nausea at 2 h and 24 h and higher scores for pruritus at 2 h compared with the plain group. Addition of adrenaline to pethidine for patient-controlled epidural analgesia does not appear to have significant clinical advantages.
A double catheter, single interspace combined spinal-epidural anaesthetic was performed in 12 ASA grade 3 patients. The technique failed in one patient in whom the intrathecal catheter could not be inserted satisfactorily. In another patient, the epidural catheter was accidentally placed intrathecally. The maximum height of the block obtained with hyperbaric lignocaine or bupivacaine was below T,, in all patients and there were no adverse cardiovascular changes. As opposed to a classical combined spinal-epidural block, this technique is most suitable for very debilitated patients. The advantages are the ability to titrate the intrathecal dose of the local anaesthetic to achieve the desired dermatomal level and to test the correct position of the epidural catheter before injecting drugs intrathecally.
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