Asunto(s)
Vidrio , Residuos Sanitarios , Metales , Quirófanos/organización & administración , Reciclaje/economía , Anestesia , CarbonoRESUMEN
BACKGROUND: To determine if oral oxycodone (OOXY) could provide equivalent postoperative analgesia and a similar side-effect profile to i.v. patient-controlled morphine in patients undergoing elective primary total hip replacement (THR) under spinal anaesthesia. METHODS: We studied 110 consecutive patients aged 60-85 yr. After operation, patients were randomly allocated to receive either oral controlled- and immediate-release OOXY or i.v. patient-controlled analgesia (IVPCA) with morphine. Both groups received regular co-analgesia and antiemetics. The primary outcome measures were: (i) postoperative pain at rest and movement and (ii) nausea score recorded 12 hourly. The secondary outcome measures were: (i) time to first mobilization, (ii) total amount of opioid consumed, (iii) number of additional antiemetic doses, and (iv) time to analgesic discontinuation. RESULTS: There were no statistically significant differences in the primary outcome measures of pain at rest and movement (P>0.05, 95% confidence intervals -0.41, +0.96) or nausea score (P>0.5). The secondary outcome measures showed no significant difference in the total amount of opioid consumed (102 vs 63 mg; P>0.05) or time to mobilization (24.45 vs 26.6 h, P=0.2). The number of antiemetic doses required in the first 24 h was significantly lower in the OOXY group (1.1 vs 1.4, P<0.05). The time to analgesic discontinuation was significantly shorter in the OOXY group (50.5 vs 56.6 h, P<0.05). Oral analgesia with OOXY was approximately GBP 10 less expensive per patient than IVPCA. CONCLUSIONS: Oral analgesia with OOXY after THR offers non-inferior analgesia to IVPCA and may offer some logistical and cost advantages.
Asunto(s)
Analgesia Controlada por el Paciente/métodos , Analgésicos Opioides/administración & dosificación , Artroplastia de Reemplazo de Cadera , Oxicodona/administración & dosificación , Dolor Postoperatorio/prevención & control , Administración Oral , Anciano , Anciano de 80 o más Años , Analgesia Controlada por el Paciente/efectos adversos , Analgésicos Opioides/efectos adversos , Anestesia Raquidea , Antieméticos/administración & dosificación , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/efectos adversos , Oxicodona/efectos adversos , Dimensión del Dolor/métodos , Cuidados Posoperatorios/métodos , Náusea y Vómito Posoperatorios/inducido químicamente , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Resultado del TratamientoRESUMEN
We present a case of profound postoperative muscle weakness in a patient who had been treated with infliximab, and whose weakness had not manifested pre-operatively. We believe this to be the first case report of infliximab-related muscle weakness manifesting immediately after anaesthesia.
Asunto(s)
Antiinflamatorios/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Debilidad Muscular/inducido químicamente , Complicaciones Posoperatorias/inducido químicamente , Adulto , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Infliximab , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
We report a case in which the signs of a malignant meningitis could have been confused with complications of an in-dwelling epidural catheter which was being used for analgesia. This confusion could have had disastrous implications for the patient's pain relief. We also discuss some of the issues and problems surrounding the use of in-dwelling epidurals in terminal care patients.
