SummaryTransdermal hyoscine (Scopoderm TTS CIBA) was compared with placebo in 67 patients receiving postoperative analgesia via a patient-controlled analgesia system. AN patienrs underwent an abdominal hysterectomy and had a standard anaesthetic. They werefiillowed up in recovery and daily,for 3 days postoperatively. Fewer patients in the hyoscine group suffered emetic sequelae in recovery and on the third postoperative day ( p < 0.05). The hyoscine group received h a y the number of supplementary antiemetic doses compared to placebo. However, despite transdermal hyoscine there was still a high (78%) incidence of nausea and vomiting. The only SignjJcant ( p < 0.05) increase in side effects attributable to hyoscine was a higher reported incidence of visual disturbance on the second day. Key wordsComplications; nausea, vomiting. Antiemetic; transdermal hyoscine. Analgesia; patient controlled analgesia.Patient-controlled analgesia (PCA) is used frequently in our hospital but we have observed a high incidence of nausea and vomiting with this technique [I]. This may in part be due to a reluctance to administer intramuscular antiemetics. Antiemetics are not administered routinely with PCA, unlike when intramuscular opioids are used. Clearly an alternative to the intramuscular route of administration of antiemetics would be desirable. Transdermal hyoscine has been shown to be an effective antiemetic for motion sickness [2-41; however, its use for preventing postoperative nausea has not been so well demonstrated [5-71. These studies used intramuscular postoperative analgesic regimens which result in peaks and troughs of opioid blood concentration. Patients receiving PCA are prescribed small doses of analgesia which they are able to self-administer at frequent intervals and may be expected to have a more constant blood concentration. Transdermal drug delivery also offers a mechanism to achieve and maintain a relatively constant drug concentration [8]. This was the rationale for studying the effectiveness of transdermal hyoscine in patients receiving PCA. MethodPatients aged between 18 and 65 years and of ASA status 1 or 2 requiring general anaesthesia for abdominal hysterectomy were recruited into the trial. The study was approved by the Hospital Medical Ethics Committee and written informed consent was obtained. The patients were randomly allocated to receive either a hyoscine transdermal patch or a matching placebo patch. On the evening before surgery the use of PCA was explained and patients were informed that an intramuscular antiemetic would be available on request postoperatively.Oral temazepam 20 mg was given 2 h pre-operatively and the patch, or placebo, applied behind the ear. The placebo was a standard waterproof dressing (Johnson and Johnson) and each hyoscine patch was covered by a similar dressing, so that its identity could not be distinguished from placebo by patient or assessor. The patches were applied by a nurse who was not involved with subsequent assessment.A standard anaesthetic was given consisting ...
SummaryThe Graseby patient-controlled analgesia system was evaluated in the laboratory and in clinical use. The problems encountered with eight examples used to treat 510 patients are reported. Laboratory performance revealed the unit to be accurate at infusion volumes of I and 2 ml.
respiratory arrest and died. No additional information was obtained at post-mortem examination. Presumably in our patient the normal blood loss from the corpus luteum was magnified by anticoagulation. Menorrhagia and irregular prolonged menstrual cycles are common in renal failure, but some of these cycles are ovulatory.1 Often an oral contraceptive agent is advised to reduce the menstrual blood loss in these patients, who are already anaemic. A more simple approach would be to use medroxyprogesterone 150 mg intramuscularly three-monthly. This would prevent ovulation and conception and would perhaps abolish menstruation. There may therefore be a place for the regular use of a long-acting progesterone in some menstruating women being treated by chronic haemodialysis. JEAN GLASS ALISTAIR IMRIE ROGER GABRIEL
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.