Purpose: To compare the effect on the incidence of motor block by reducing the concentration of ropivacaine from 0.2% to 0. 125% in parturient-controlled epidural analgesia (PCEA) for labour. Methods: Randomized, controlled and double-blind trial involving parturients in early labour who received demand-only PCEA regimen (bolus 5 ml, lockout I 0 min, maximum volume per hour of 20 ml) with either 0.2% (R0.2 group, n=25) or 0.125% (R0.125 group, n=25) ropivacaine. Pain scores, the degree of motor block, the rate of drug consumption, the proportion of good to total PCEA demands and the overall satisfaction scores were documented. Kesttlts: Fewer parturients in the R0.125 group had lower limb motor block (4 vs I I, P < 0.05) although the degree of block was mild in all the affected parturients. The ratio of good to total PCEA demands was more favourable in the R0.2% group (median 0.72 vs 0.52, P < 0.01) although the hourly rate of ropivacaine consumption, the degree of pain relief, the maternal-fetal outcome and the overall satisfaction scores were similar. Conclusion: Both ropivacaine 0.2% and 0. 125% provided comparably effective analgesia but motor block occurred more commonly in the 0.2% group.Objectif : Comparer I'effet, sur I'incidence du blocage moteur, de la r~duction de la concentration de ropivaca'r de 0,2 % & 0,125 % pendant I'analg&ie ~pidurale contr61~e par la patiente (AECP) en travail obst6trical. M&hode : On a proc~d~ & un essai randomis& contr61~ et & double inconnu aupr~s de parturientes, au d~but de leur travail, qui ont re(su un ragime d'AECP sur demande seulement (un bolus de 5 ml, une p&iode r~frac-taire de I 0 min, un volume maximal de 20 ml & I'heure) avec, soit de la ropivaca'fne & 0,2 % (groupe R0.2, n = 25), soit ~ 0, 125 % (groupe R0. 125, n = 25). On a document6 : les scores de douleur, I'intensit~ du blocage moteur, la fr~quence de la prise de m6dicament, la proportion de demandes efficaces sur les demandes totales d'AECP et I'indice de satisfaction globale. 1Msultat~ : Peu de patientes du groupe R0.125 ont eu un blocage moteur des membres inf&ieurs (4 vs I I, P < 0,05) bien que le blocage n'ait pas ~t~ important chez les parturientes touch&s. La proportion de demandes efficaces sur les demandes totales d'AECP a ~t~ meilleure dans le groupe R0.2 % (m6diane de 0,72 vs 0,52, P < 0,01 ), mais la fr~quence horaire de consommation de ropivaca'ine, le degr~ de soulagement de la douleur, I'~vo-lution fceto-maternelle et la satisfaction globale ont ~t6 similaires. Conclusion : La ropivaca'fne 0,2 % et 0,125 % produisent des effets analg&iques comparables, mais le blocage moteur survient plus souvent avec une concentration de 0,2 %.
The aim of this study was to explore the benefits of music therapy (MT) for children with cancer over the course of their treatment in an acute paediatric hospital setting in Singapore. Twenty-five children undergoing cancer treatment received MT sessions as part of a multidisciplinary team rehabilitation intervention from March 2017 to January 2020. A total of 37 individualised goals were developed by the music therapist for the cohort. Goals were scored via the Goal Attainment Scale at 3-month intervals up to 1 year. Descriptive statistics and correlation analysis were used to evaluate the findings. The rate of goal achievement was 89.2% over 180 MT sessions (M = 7.20, SD = 6.45). Children diagnosed with brain tumours had the highest frequency of MT sessions (M = 9.11, SD = 7.79). Most of the goals targeted the regulation of mood and morale through music. There was a positive correlation found between goals and sessions (rs = 0.56, p = 0.004). Age of the children was not correlated with the number of sessions received (rs= −0.19, p = 0.354). MT has been found to be an accessible and effective intervention in addressing functional and emotional goals for children across all ages who are undergoing cancer treatment.
SummaryNinety-one patients were randomly allocated to one of two groups. Group A was induced with a single vital capacity breath of 6% (end-tidal) sevoflurane in nitrous oxide±oxygen (2 : 1 l.min 21 ), whereas group B was induced with intravenous fentanyl 1 mg.kg 21 1 propofol 2 mg.kg 21 followed by nitrous oxide±oxygen (2 : 1 l.min 21 ) and sevoflurane. Induction was considered to have been achieved when the bispectral index value decreased to below 70. Mean induction time in group A (95.2 s, 95% CI 88.5±101.9 s) was longer than group B (70.3 s, 95% CI 66.3±74.3 s; p , 0.0001). Mild coughing was more common in group A, but relative hypotension was more common in group B. There was no difference in the emergence times. Thirty minutes after emergence, there was no difference in the incidence of adverse effects, with the exception of essentially mild abdominal pain which was more frequent in group A.
Purpose: a) To evaluate the effect of adding 1.25 mg of bupivacaine to intrathecal fentanyl on the duration of analgesia in an Asian population and b) to examine if the baricity of the local anesthetic at this dose has any bearing on the duration and quality of block.Methods: Forty-eight parturients in early labour received combined spinal epidural (CSE) analgesia to evaluate a) the effect of adding 1.25 mg of bupivacaine to intrathecal (IT) fentanyl 25 µg on the duration of analgesia and b) the effect of baricity of intrathecal local anesthetic on the duration and quality of the block. Patients were randomly allocated to receive: IT fentanyl 25 µg plus normal saline (Group f, n=16), IT fentanyl 25 µg plus plain bupivacaine 1.25 mg (Group f+pb, n=16) and IT fentanyl 25 µg plus heavy bupivacaine 1.25 mg (Group f+hb, n=16). The two components of the IT injectate (total of 2.25 mL) were given sequentially.Results: Group f+hb had the lowest sensory dermatomal block (T7 vs T4 (Group f), T5 (Group f+pb), P <0.01). There were no differences in the duration of analgesia and incidence of side effects among the groups. Conclusion:We found no advantage of adding 1.25 mg bupivacaine to fentanyl 25 µg. At this dose, the baricity of bupivacaine has no effect on the duration of analgesia. Résultats : Le Groupe f+bh a présenté le bloc sensoriel le plus bas (T7 vs T4 (Groupe f), T5 (Groupe f+bs), P < 0,01). La durée de l'analgésie et l'incidence d'effets secondaires n'ont présenté aucune différence intergroupe.Conclusion : L'ajout de 1,25 mg de bupivacaïne à 25 µg de fentanyl n'a présenté aucun avantage. À cette dose, la baricité de la bupivacaïne n'a pas d'effet sur la durée de l'analgésie.OMBINED spinal epidural (CSE) analgesia is an effective and accepted mode of providing pain relief in labour. Intrathecal (IT) fentanyl 25 µg has been shown to provide good analgesia in early labour. 1 Studies have suggested that the addition of a small amount of local anesthetic augments the effect of IT opioids by increasing the duration of the block and speeding the onset of analgesia. 2,3 Lee et al. showed that, with bupivacaine, 1.25 mg produced a similar onset and quality of analgesia as 2.5 mg when added to fentanyl 25 µg intrathecally as part of CSE in the first stage of labour. 4 The reduced dose resulted in less motor and sensory block, and also decreased the incidence of hypotension but had a shorter duration of analgesia.
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