Efficacy and Safety of Low-Dose versus High-Dose Postoperative Intrathecal Morphine in 62 Women Undergoing Elective Cesarean Section Delivery at Full Term.

BACKGROUND Adequate pain control is desired in women undergoing cesarean section. This study aimed to compare the efficacy and safety of low- and high-dose postoperative intrathecal morphine in 62 women undergoing elective cesarean section delivery at full term. MATERIAL AND METHODS We performed a prospective, randomized, controlled, multicenter clinical study from April to November 2022. Full-term, 22-38-year-old pregnant women who were singleton pregnancies, weighing 55-80 kg, scheduled for elective cesarean section, were enrolled. A total of 62 patients were randomly assigned into either the low-dose (60 µg morphine, N=32) or high-dose (100 µg morphine, N=30) group. Post-cesarean pain intensity was recorded at 4, 12, and 24 hours. Patients requiring additional rescue analgesics or with adverse effects were documented. RESULTS There were no differences in age, weight, height, gestational age, or operating time between the 2 groups (all P>0.05). The 2 groups also had no statistically significant differences in the resting and exercise pain intensities at 4, 12, and 24 hours after cesarean section (P>0.05). Most patients (53 patients) did not require additional analgesics, suggesting an overall successful analgesic rate of 85.5%. The low-dose group had a lower incidence of pruritus than the high-dose group (13% vs 40%, P=0.029). The 2 groups had no differences in the other adverse effects. CONCLUSIONS A single dose of intrathecal 60 µg morphine could provide adequate analgesia comparable with 100 µg morphine, with a lower incidence of pruritus, in Chinese women after cesarean delivery.

Application of Optimized Ultrasonic Localization System for Radial Artery Puncture by Intern Doctors: A Randomized Trial.

BACKGROUND Ultrasound with developing line may by suitable for medical personnel who are inexperienced in the use of ultrasound-guided radial artery puncture. In this trial, we assessed whether this technology could increase the success rate of radial artery puncture performed by interns. MATERIAL AND METHODS Seventy-seven patients undergoing general anesthesia were enrolled and randomly divided into 2 groups: an ultrasound with developing line group and a traditional ultrasound group. All radial artery punctures were performed by interns who received theoretical explanation (including video demonstration of puncture) and on-site guidance puncture once. The primary end-point was the success rate of cannulation at the first attempt and the secondary end-point was cannulation failure rate. RESULTS The success rate of cannulation at the first attempt in ultrasound in the developing line group was significantly higher than that in the traditional ultrasound group (proportion difference: 34.21%, 95% confidence interval [CI], -0.5483 to -0.1334; P=0.0025). However, no significant between-group difference was observed with respect to failure rate (mean difference 95% CI, (-0.0084 to 0.2743; P=0.0866). The ultrasonic location time in the ultrasound with developing line group was significantly lower than that in the traditional ultrasound group (mean difference -12.4 seconds, 95% CI, 10.64 to 13.98 s; P<0.0000). CONCLUSIONS Use of ultrasound with developing line significantly improved the success rate of radial artery puncture performed by interns as compared to that with use of traditional dynamic ultrasound guidance technology.

[The influences of silent cerebral infarction and hypertension on brain atrophy in normal adults].

AIM: We studied the influences of silent brain infarction (SBI) and hypertension on brain atrophy and its longitudinal progression in healthy adults. METHODS: MRI scans were performed on 109 neurologically normal adults (mean age, 58.6+/-5.8 years), with follow-up at an average of 4.9 years later. Patient histories of hypertension, smoking habits, and alcohol consumption were examined. We evaluated brain atrophy using the brain atrophy index (BAI; the ratio of the brain area to the intracranial area) and the ventricular atrophy index (VAI; the ratio of the ventricular area to the brain area) on MRI T1-weighted images at the levels of the basal ganglia and lateral ventricle in horizontal sections. RESULTS: There were no differences in age, sex, dyslipidemia, BMI, smoking habit, and alcohol consumption between the normal group and the SBI or hypertension group. The BAI was significantly lower at entry for the SBI (+) group than for the SBI (-) group at both the basal ganglia and lateral ventricle levels (basal ganglia level, p=0.02; and lateral ventricle level, p=0.05). Moreover, the VAI was significantly higher at entry for the SBI (+) group than for the SBI (-) group at the lateral ventricle level (p=0.03). Furthermore, the BAI was significantly lower at entry for the hypertensive group than for the non-hypertensive group at the basal ganglia level (p=0.007). There were no significant differences in the annual variations of the BAI and VAI between the normal group and the SBI (+) or hypertensive group. CONCLUSION: The present results suggest that the SBI and hypertension are accelerating factors for brain atrophy and ventricular dilatation.