The benefits, risks and resource implications of providing an Acute Pain Service were assessed during the first year of the service. Six hundred and sixty patients recovering from major surgery were treated with patient-controlled analgesia (510 patients) or extradural infusion analgesia (150 patients). The results of a prospective outcome study showed that pain control was good: more than 60% of patients scored their pain as mild during the first 24 h. Only 10% of patients complained of severe postoperative pain. Eight patients developed potentially serious complications including respiratory depression and hypotension; the diagnosis and management of these problems on general wards is discussed. Retrospective analysis of the incidence of postoperative chest infection in surgical patients showed a marked reduction during the first year of the service (1.3% in 1988, 0.4% in 1989-90 (P less than 0.01].
Domperidone 20 mg, droperidol 2.5 mg, metoclopramide 10 mg and placebo (saline) were given i.v. 10 min before the end of anaesthesia, to 200 women undergoing major gynaecological surgery, and the incidence of postoperative nausea and vomiting following a standard anaesthetic technique was assessed. Droperidol was significantly more effective than domperidone, metoclopramide or placebo in reducing emetic sequelae. There were no significant differences between the groups in the incidence of extrapyramidal effects and postoperative sedation. Patients given droperidol required less postoperative analgesia than those given domperidone or metoclopramide. It was concluded that, of the drugs studied, droperidol alone was effective in protecting against nausea and vomiting after major gynaecological surgery.
The efficacy of domperidone 20 mg, droperidol 2.5 mg, metoclopramide 10 mg or placebo (saline) administered i.v. before induction of anaesthesia, was studied in 199 women undergoing gynaecological surgery as day cases. Following a standardized general anaesthetic technique, droperidol or metoclopramide significantly reduced the incidence of nausea and vomiting; domperidone decreased the incidence of postoperative nausea alone. The occurrence of extrapyramidal reactions was similar in all groups. Patients treated with antiemetics were no more sedated than those given placebo. Those receiving droperidol complained of significantly less postoperative pain than those who had received domperidone or metoclopramide.
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 ...
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