Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain.

BACKGROUND: Different methods and propofol formulations have been used to decrease propofol injection pain, but it remains an unresolved problem. We aimed to investigate the effect of i.v. acetaminophen pretreatment on the propofol injection pain. METHODS: One hundred and fifty ASA I-II patients undergoing general anaesthesia were randomly allocated into three groups. A 20-gauge catheter was inserted into a superficial radial vein of the left hand, and after the occlusion of venous drainage, Groups I, II, and III were pretreated with 40 mg of lidocaine in saline, 50 mg of i.v. acetaminophen, and 5 ml of saline, respectively. The occlusion was released after 2 min and one-fourth of the total propofol dose was injected into the vein over a period of 5 s. During the injection of both pretreatment solution and propofol, patients' pain was assessed and recorded as 0-3, corresponding to no, mild, moderate or severe pain, respectively. Chi2 and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P<0.05. RESULTS: Patient characteristics were similar among the groups. Incidence of pain on injection of propofol in control, i.v. acetaminophen, and lidocaine groups was 64%, 22% and 8%, respectively (P<0.05). CONCLUSIONS: Pretreatment with i.v. acetaminophen seems to be effective in attenuating pain during i.v. injection of propofol.

Ketamine gargle for attenuating postoperative sore throat.

BACKGROUND: Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sore throat (POST) with reported incidences of 21-65%. We compared the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. METHODS: Forty-six, ASA I-II, patients undergoing elective surgery for septorhinoplasty under general anaesthesia were enrolled in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly allocated into two groups of 23 subjects each: Group C, saline 30 ml; Group K, ketamine 40 mg in saline 30 ml. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0-3). RESULTS: POST occurred more frequently in Group C, when compared with Group K, at 0, 2, and 24 h and significantly more patients suffered severe POST in Group C at 4 and 24 h compared with Group K (P<0.05). CONCLUSIONS: Ketamine gargle significantly reduced the incidence and severity of POST.

Topical ketamine and morphine for post-tonsillectomy pain.

BACKGROUND AND OBJECTIVES: Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non-opioid analgesics. Despite the use of different surgical and anaesthetic techniques in the search for safe and effective post-tonsillectomy pain relief, this problem remains a clinical dilemma. The aim of the current study was to evaluate the potential effects of topically administered ketamine and morphine by an oral rinse into the tonsillar fossae. METHODS: In all, 60 children, 15 for each group, aged between 3 and 12 yr scheduled for tonsillectomy were randomly assigned to one of four groups. Study drugs were administered to both tonsillar fossae for 5 min. Group K received 0.4 mL (20 mg) ketamine in 10 mL artificial saliva, Group KM received 0.4 mL (20 mg) ketamine + 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group M received 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group C received only 10 mL artificial saliva. Postoperative pain, nausea, vomiting, sedation and bleeding were evaluated. RESULTS: Pain scores were higher in the control group at arrival in the recovery ward (P < 0.05). Morphine and ketamine groups had longer effective analgesia time than the morphine + ketamine and control groups. The 24-h analgesic consumption was significantly higher in the control group. CONCLUSION: Topical ketamine and morphine seems to be a safe and easy analgesic approach for decreasing adenotonsillectomy pain.

Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion.

BACKGROUND AND OBJECTIVES: There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol. METHODS: In all, 52 patients, ASA I-II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 microg kg(-1) fentanyl (in 10 mL normal saline) and Group D received 1 microg kg(-1) dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg(-1) propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion. RESULTS: More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001). CONCLUSION: Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Remifentanil and etomidate for laryngeal mask airway insertion.

Etomidate does not depress the upper airway reflexes, making it difficult to insert a laryngeal mask airway (LMA) when using it for anaesthesia. This study investigated the effect of adding remifentanil to etomidate for LMA insertion. Fifty adult patients, undergoing cystoscopy, were randomized to two groups. The propofol-remifentanil group (n=25) received propofol anaesthesia induction (2.5 mg/kg) and a remifentanil bolus of 0.5 microg/kg, followed by a 2-min remifentanil infusion of 0.05 microg/kg per min. The etomidate-remifentanil group (n=25) received etomidate anaesthesia induction (0.3 mg/kg) and remifentanil as described. The LMA was inserted by a blinded anaesthetist who assessed a number of parameters. Only 13 LMAs were inserted at the first attempt in the etomidate-remifentanil group compared with 23 in the propofol-remifentanil group. Gagging, chest rigidity and myoclonus occurred significantly more frequently in the etomidate-remifentanil group. We conclude that the addition of remifentanil to etomidate anaesthesia induction does not improve LMA insertion.

WITHDRAWN The analgesic effect of paracetamol when added to lidocaine for intravenous regional anesthesia.

Ahead of Print article withdrawn by publisher AIM: Intravenous regional anesthesia (IVRA) is frequently used in patients who will undergo upper extremity surgical operations for its ease of use, rapid effectiveness and short hospitalization period. Different drug combinations have been used to overcome some systemic adverse effects and to increase the postoperative analgesic effectiveness. In our study, we evaluated the effects of paracetamol (Perfalgan) when added to lidocaine for IVRA, looking specifically at tourniquet pain and postoperative pain. METHODS: Ninety patients undergoing elective hand surgery with IVRA were randomly assigned to three groups to receive either IV saline and C-IVRA with 0.5% lidocaine 3 mg/kg (control group, N=30), IV saline and IVRA with 0.5% lidocaine and 20 mL paracetamol (10 mg/cc) (P-IVRA group, N=30) or IV paracetamol and IVRA with 0.5% lidocaine (L-IV group, N=30). The following were measured: 1) sensory and motor block onset and recovery time, 2) tourniquet pain after tourniquet application and at 10, 20 and 30 min after tourniquet deflation, 3) the visual analog scale (VAS) scores of tourniquet pain at 30 min and 1, 2, 4, 6 and 24 h postoperatively, 4) the time to first analgesic requirement, 5) total analgesic consumption in 24 h and 6) side effects. RESULTS: Sensory and motor block onset and recovery times were similar in both groups. VAS scores of tourniquet pain were lower in group P-IRVA at 1, 2, 4, 6, and 24 h, postoperatively (P<0.01). Anesthesia quality, as determined by the anesthesiologist and surgeon, was similar in both groups. The time to the first postoperative analgesic request was 67.83±57.48 min in group C-IRVA and 93±80.79 min in group P-IRVA (P<0.05). Paracetamol consumption was significantly less in group P-IRVA (1.60± 1 [tablets]) when compared with group C-IRVA (2.45±0.9; P<0.05). CONCLUSIONS: Perfalgan as an adjunct to lidocaine improves postoperative analgesia in IVRA without adverse effects.

Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section.

BACKGROUND: We aimed to evaluate the efficacy of subhypnotic doses of midazolam and propofol for peripartum nausea and vomiting during regional anesthesia for elective cesarean section in order to prevent emesis in at least 50% of patients. METHODS: A prospective, double blind, placebo-controlled study was carried out. Patients were randomly allocated to one of three groups to receive placebo (saline, N=28), propofol (20 mg bolus and 1.0 mg x kg(-1) x h(-1) infusion, N=30), and midazolam (1 mg bolus and 1.0 mg x h(-1) infusion, N=30) at subhypnotic doses intravenously (i.v.) immediately after the umbilical cord was clamped. Bupivacaine hydrochloride (8-10 mg) and fentanyl (10 microg) were injected into the intervertebral space for spinal anesthesia. Blood pressure was monitored at 2 min intervals and intraoperative postdelivery emetic episodes and ephedrine consumption were recorded. The study was carried out at the Anesthesiology Department, Hacettepe University, Turkey, hospitalized care. We included 90 parturients with ASA physical status I and II between the ages of 20 and 38 years undergoing spinal anesthesia for elective cesarean delivery to evaluate the efficacy of subhypnotic doses of propofol and midazolam and, in particular, the incidence of nausea, retching, and vomiting intraoperatively. RESULTS: The incidence of nausea, retching, and vomiting was significantly higher in the control group, compared to the propofol and midazolam groups. Total ephedrine consumption was significantly higher in the control group compared to the propofol and midazolam groups. CONCLUSION: A subhypnotic dose of midazolam (1 mg x h(-1)) was as effective as the subhypnotic dose of propofol (1 mg x kg(-1) x h(-1)) for the prevention of nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia.