Biomedical subjects

S T Ho

Publications and source records attributed to S T Ho.

165 records · Page 10Linked to original sources

PubMedDate not supplied

Comparison of intravenous nalbuphine infusion versus saline as an adjuvant for epidural morphine.

BACKGROUND AND OBJECTIVES: Radical (three-quadrant) hemorrhoidectomy is a major anorectal surgery that may necessitate aggressive pain management. This study was undertaken to determine whether intravenous nalbuphine infusion as an adjuvant to epidural morphine could offer not only a good quality of pain relief but also a lower incidence of side effects. METHODS: Sixty patients requiring epidural anesthesia for radical hemorrhoidectomy were enrolled in a randomized, double-blind study. At the end of the surgery, all patients received epidural morphine 4 mg for relief of postoperative pain. Thereafter, 2 mg and 3 mg of morphine were administered via the epidural route at 8 p.m. and 8 a.m., respectively, for a 48-hour observation period. Patients in group 1 received an adjuvant intravenous infusion of nalbuphine 15 micrograms/kg/h, whereas patients in group 2 received intravenous saline only. A rescue analgesic of intramuscular meperidine 40 mg (every 4 hours) was available for each patient. RESULTS: All patients had adequate postoperative pain relief. Cumulative (48-hour) analgesic requirements were similar. During the 48-hour observation period, one patient in group 1 and six in group 2 demonstrated a PaCO2 above 45 mm Hg. No patient had an SaO2 below 90%. The incidence of nausea and/or vomiting was 13% in group 1 and 62% in group 2. The incidence of pruritus was 7% in group 1 and 62% in group 2. CONCLUSIONS: The results suggest that intravenous nalbuphine infusion as an adjuvant for epidural morphine reduces the incidence of side effects without decreasing the quality of pain relief.

Adult↗

PubMedDate not supplied

The effect of spinal versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing lower abdominal surgery.

BACKGROUND AND OBJECTIVES: Attempts to reduce central sensitization after tissue injury have led to the concept of preemptive analgesia. The aim of this study was to evaluate the effect of spinal versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing lower abdominal surgery. METHODS: Sixty women scheduled for lower abdominal surgery were randomly assigned to two groups of 30 patients each to receive spinal anesthesia (SA) or general anesthesia (GA). In the SA group, 3 mL of hyperbaric 0.5% bupivacaine was injected into the subarachnoid space through the third or fourth lumbar interspace. In the GA group, anesthesia was maintained with isoflurane and nitrous oxide. Postoperative pain was assessed for 48 hours by a visual analog scale of pain at rest and during cough and by patient-controlled cumulative morphine doses. RESULTS: The pain score at rest was significantly lower in the SA group than in the GA group 6-24 hours after surgery. The cough-associated pain score was also lower in the SA group than in the GA group at 6-30 hours after surgery. Furthermore, the SA group consumed less patient-controlled morphine than did the GA group within the first 24 postoperative hours. CONCLUSION: Postoperative pain after lower abdominal surgery can be significantly decreased if the surgery is performed with use of SA.

Abdomen↗

PubMedDate not supplied

Ketamine potentiates analgesic effect of morphine in postoperative epidural pain control.

BACKGROUND AND OBJECTIVES: Ketamine is currently the only N-methyl-D-aspartate receptor channel blocker in clinical use. This study evaluated the analgesic efficacy of epidurally coadministered ketamine and morphine in postoperative pain control. METHODS: The patient population consisted of ASA class I and II patients undergoing major joint replacement. Epidural lidocaine was used as the primary anesthesia for the surgery. In phase I of the study, either ketamine (10-30 mg) or morphine (0.5-2 mg) was administered via epidural catheter immediately after surgery. This was done to evaluate the dose-response effect of these drugs when used for postoperative pain relief, and the results were applied to phase II of the study, in which all patients received ketamine pretreatment (total 30 mg) with each dose of lidocaine administered before and during surgery. Forty patients were randomly divided into four groups, each of which received one of three different pain control regimens mixed with 10 ml of saline: group B received 10 mg ketamine, group C 2 mg morphine, and group D 10 mg ketamine plus 0.5 mg morphine while the control group A received 10 mL of saline with no additive. The intensity of pain expressed by patients, as well as the number of intramuscular meperidine (1 mg/kg) injections administered and any side effects that may have occurred, were recorded. RESULTS: Ketamine produced no significant pain relief. A 2-mg morphine dose did produce significant analgesia but was accompanied by a high incidence of side effects. Co-administration of subanalgesic doses of ketamine, 10 mg and morphine, 0.5 mg, however, also produced a strong analgesic effect. CONCLUSIONS: Ketamine, although not itself an epidural analgesic agent, potentiates the analgesic effect of morphine, especially when administered as a pretreatment. The resulting lowered dosage of epidural morphine needed for postoperative pain relief reduces, in turn, the incidence of side effects. Pretreatment of patients with ketamine epidurally, followed by injections of combined morphine and ketamine could be a promising new analgesic regimen.

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