F. Kern

Peridural Opiate Analgesia: Clinical Results of a 2-Year Study

Postoperative pain relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.

Diazepam Dosage and Timing in Ketamine Combination Anaesthesia: A Double-Blind Study

A form of combination anaesthesia using ketamine, diazepam, alcuronium and nitrous oxide was used in 41 patients over 65 years requiring abdominal surgery. The patients were premedicated with droperidol 2.5-7.5 mg im. At induction the patients received diazepam 5 mg. ketamine 2 mg/kg and alcuronium 0.2 mg/kg. Anaesthesia was maintained with a continuous, steady injection of ketamine 2.5 mg/kg/h and nitrous oxide-oxygen with controlled ventilation. Four minutes before incision the patients received 1 ml of coded solution and at the end of anaesthesia the same solution, which contained either 5 mg/ml diazepam or its solvent only. There were no statistically significant differences between the two groups, i.e. patients receiving either 15 or 5 mg of diazepam. The incidence of bad dreams was 5 per cent, i.e. one patient in each group. Only one patient vomited and one had pronounced nausea in group D5. According to the anaesthesiologists, the anaesthesia nurses and the patients subjective evaluations this type of combination anaesthesia was found to be highly acceptable. Despite there being no statistically significant differences between the patients who received 5 + 5 + 5 mg of diazepam compared to those receiving 5 + 0 + 0 mg, the figures in results per se incline in favour of the use of 5 + 5 + 5 of diazepam.