The analgesic efficacy and side-effects of combined epidural infusion of bupivacaine and morphine, in comparison with these drugs alone, for postoperative analgesia after hysterectomy (60 patients) were evaluated. Before general anaesthesia, all patients had an epidural catheter placed (Th11-12) and 20 ml of 0.5%, bupivacaine was injected. In random order, epidural infusion was continued for 24 h with either 0.25% bupivacaine 4 ml.h-1 (BUPI-group), a bolus of 2 mg of morphine followed by morphine 0.2 mg.h-1 (MO-group), or a combination of the two drugs (COMB-group). A urinary bladder catheter was kept for 24 h. Supplementary postoperative pain medications were i.m. morphine 0.1 mg.kg-1 or rectal indomethacin 50 mg, on request. Immediately after awakening from general anaesthesia and transfer to the recovery room, 18/20 of the BUPI-group patients, 17/20 of the MO-group patients and 19/20 of the COMB-group patients were pain-free. In the postoperative evening and the first postoperative morning, the corresponding figures were 7/20 and 10/20 in the BUPI-group, 15/20 and 15/20 in the MO-group, and 18/20 and 15/20 in the COMB-group (postop, evening; P less than 0.01 BUPI vs. others). The number of patients requiring supplementary analgesics (morphine and indomethacin during the first 24 h was greatest in the BUPI-group P less than 0.01). The number of patients who vomited during the 24-h period was 3 in the BUPI-group, 9 in the MO-group and 5 in the COMB-group.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy and side effects of epidural bolus injection of 4 mg of morphine in a volume of 2 ml, 10 ml, or 20 ml (groups I, II and III) for postoperative analgesia after caesarean section (60 patients) were evaluated. All patients had epidural anaesthesia established up to T4 level with 0.5% bupivacaine 18-20 ml, supplemented with 2% lidocaine with adrenaline, when necessary. Morphine 4 mg in either of the three volumes was injected through the epidural catheter in random order after delivery of the baby. Six patients in each group reported no pain during the 24-h follow-up period. No additional pain medication during the 24 h after surgery was required in 11, 14 and 10 patients in groups I, II and III, respectively. Most of the others managed with the addition of a single dose of rectal ketoprofen. There were no differences in analgesic therapy between the groups. Pruritus was the most common adverse effect (18/20, 19/20 and 18/20 in groups I, II and III, respectively). 10/20, 12/20 and 14/20 (N.S.) patients had nausea and vomiting in groups I, II and III, respectively. Metoclopramide, prescribed for persistent nausea, was given to 4/20 patients in group I, 6/20 patients in group II and 9/20 patients in group III (N.S.). After removal of the urinary catheter 7/20 patient in group III required carbachol for urinary retention compared to 3/20 and 4/20 patients in groups I and II (N.S.).(ABSTRACT TRUNCATED AT 250 WORDS)

Pirkko Eklund MD, Markku Paloheimo MO PHDPurpose: The effect of ranitidine on postoperative nausea and vomiting (PONV) Although 5-HT 3 receptor antagonist drugs such as ondansetron may. be effective anti-emetics after anaes-CAN J ANAESTH 1996/43:2 Ippl06-9

No abstract

The anaesthesiological problems related to prolonged reconstructive plastic surgery in 22 patients were investigated in retrospect. Surgery consisted mainly of reconstructions, including microvascularization (7 emergency reimplantations, 15 plastic reconstructions), and the duration of the balanced anaesthesias varied between 5 h 10 min and 15 h 35 min. As the patients were relatively young and healthy, no serious cardiovascular complications occurred. Blood loss was intentionally replaced with dextran, in most instances, and in a group of 15 elective patients, mean haematocrit level decreased from 0.41 to 0.31 during surgery. In about half of the material, the central temperature was monitored; it remained within 35.8-38 degrees C. In the longest anaesthesia (15 h 35 min) the temperature stayed within 0.4 degrees C, the patient placed on a heating mattress. In 2 patients, transient paresis of the muscles of the hand, which was exposed and abducted for i.v. infusion and blood pressure recording, was observed. A questionnaire was sent to the patients and 19 of 20 responded. The predominant subjective complaint was nausea, while sensations following catheterization of the bladder were also a common untoward recollection. One patient developed laryngeal oedema after extubation and about a third experienced breathing difficulties on awakening from the anaesthesia. Postoperative pain appeared not to be a significant problem.