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PubMedDate not supplied

Intrathecal addition of morphine to bupivacaine is not the cause of postoperative nausea and vomiting.

BACKGROUND AND OBJECTIVES: Postoperative nausea and vomiting after anesthesia is an distressing side effect. This study was undertaken to determine to what extent spinal opioids contribute to postoperative nausea and vomiting (PONV) and secondly to how effectively metoclopramide can reduce the incidence of PONV after intrathecal administration of morphine. METHODS: Patients were allocated to three groups all undergoing major joint surgery of the lower limb. In group 1 (n = 200), intrathecal anesthesia was assessed by administration of 20 mg bupivacaine and 0.2 mg morphine. In Group 2 (n = 100) intrathecal anesthesia was assessed in the same way and in addition, 20 mg metoclopramide intramuscular during maintenance of anesthesia and a second dose of 20 mg metoclopramide was administered intramuscular after arrival at the recovery room. Finally, in group 3 (n = 100), intrathecal anesthesia was assessed after administration of 20 mg bupivacaine. RESULTS: The maximum PONV percentages were 41.1%, 32.7%, and 37% in groups 1, 2, and 3, respectively. The consumption of antiemetics was similar in all groups. The number of patients who needed one or more additional antiemetics during the first 24 hours after surgery was 112 (56.6%), 57 (58%), and 60 (60%) in groups 1, 2, and 3, respectively. CONCLUSIONS: Administration of metoclopramide did not reduce the overall incidence of PONV. Our study shows no relationship between the use of intrathecal morphine and the incidence of PONV during the first 24 hours postoperative.

Adult↗

PubMedDate not supplied

Ventilatory function and continuous high thoracic epidural administration of bupivacaine with sufentanil intravenously or epidurally: a double-blind comparison.

Variables of ventilation were obtained preoperatively and during the first two postoperative days in 28 patients after thoracic surgery. All patients received 0.5% bupivacaine with epinephrine, 5 micrograms.ml-1 (5-10 ml), through an epidural catheter at the thoracic level supplemented by light general anesthesia. One hour after the initial dose of bupivacaine, patients were randomly allocated to one of two groups: an epidural (EP) sufentanil and an intravenous (IV) sufentanil group. Both groups received 0.125% bupivacaine via continuous epidural infusion postoperatively for three days. In addition, the EP group received 0.83 micrograms.ml-1 sufentanil added to the epidural infusion of 5-10 ml.hour-1, while the IV group received an identical dose of sufentanil via continuous intravenous infusion of 5-10 ml.hour-1. The ventilatory response to 5% CO2 was analyzed preoperatively and on postoperative Days 1 and 2. No significant depression in ventilatory response to CO2 could be detected by measurement of minute ventilation and mouth occlusion pressure at 100 milliseconds (P0.1). Pain measurement was assessed by blinded observers using the Inverse Visual Analog Scale, where 0 signifies most pain and 10 signifies least pain. The mean scores were above 7 in both groups and were attained at similar analgesic requirements. The incidence of side effects was not different. Only the initial mean sufentanil plasma levels in patients of the IV group were higher than those of the EP group. This study shows that the variables of ventilation were not affected by sufentanil administered via the epidural or the intravenous route, and that both techniques provided excellent pain relief when employed to supplement low-dose 0.125% bupivacaine epidurally.

Adult↗