Programmed Intermittent Epidural Bolus vs. Patient-controlled Epidural Analgesia for Maintenance of Labour Analgesia: A 2-Center, Double-blind, Randomized Study

Background and ObjectivesThe usefulness of adding bupivacaine to an opioid administered by the epidural route is controversial. This study examines both the quality of pain relief and side effects, in particular urinary retention, during patient-controlled epidural analgesia (PCEA) with sufentanil alone or in combination with two different concentrations of bupivacaine.MethodsIn a double-blind randomized study, 60 healthy young adults undergoing open knee or ankle surgery with combined spinal-epidural anesthesia received postoperative analgesia via PCEA with sufentanil alone or with 0.06% or 0.12% bupivacaine. In addition to pain scores at rest and during mobilization, bladder function was evaluated. Strict criteria were respected in scoring the occurrence of problems suggestive of urinary retention. The 24-hour analgesic consumption and the incidence of other side effects were also recorded.ResultsPatients receiving bupivacaine had better pain relief than those receiving only the opioid, but this difference was more pronounced when measuring dynamic pain scores. The consumption of sufentanil was significantly higher in the group receiving the opioid alone than in the group receiving 0.06% bupivacaine. The bupivacaine dose requirements were twice as high with the 0.12% concentration. Bladder problems occurred significantly more frequently in patients treated with the highest bupivacaine concentration. Motor impairment was not a major problem.ConclusionsA 0.06% bupivacaine-sufentanil combination offered the best results in terms of analgesic quality and lower side effects, mainly micturition problems, which may be explained by the higher consumption of local anesthetic at the higher bupivacaine concentration. Analgesic quality could not be improved by increasing the bupivacaine concentration.

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Beta Blockade Reduces Neurocardiogenic Dysfunction: A Double Blind, Placebo Controlled Randomized Study

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84200-3 ◽

1998 ◽

Vol 31 (2) ◽

pp. 114A

Author(s):

P Smits

Keyword(s):

Randomized Study ◽

Beta Blockade ◽

Double Blind ◽

Double Blind Placebo

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Ex Vivo Inhibition of Platelet Aggregation in Patients with Severe Limb Arteriopathy Treated with BAY U3405, a Specific IX A2 Receptor Antagonist

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648937 ◽

1994 ◽

Vol 72 (05) ◽

pp. 659-662 ◽

Cited By ~ 1

Author(s):

S Bellucci ◽

W Kedra ◽

H Groussin ◽

N Jaillet ◽

P Molho-Sabatier ◽

...

Keyword(s):

Platelet Aggregation ◽

Ex Vivo ◽

Randomized Study ◽

In Vivo Studies ◽

Walking Distance ◽

Peripheral Blood Flow ◽

Walking Ability ◽

Double Blind ◽

Platelet Factor

SummaryA double-blind, placebo-controlled randomized study with BAY U3405, a specific thromboxane A2 (TX A2) receptor blocker, was performed in patients suffering from severe stade II limb arteriopathy. BAY U3405 or placebo was administered in 16 patients at 20 mg four times a day (from day 1 to day 3). Hemostatic studies were done before therapy, and on day 2 and day 3 under therapy. On day 3, BAY U3405 was shown to induce a highly statistically significant decrease of the velocity and the intensity of the aggregations mediated by arachidonic acid (56 ± 37% for the velocity, 58 ± 26% for the intensity) or by U46619 endoperoxide analogue (36 ± 35% for the velocity, 37 ± 27% for the intensity). Similar results were already observed on day 2. By contrast, such a decrease was not noticed with ADP mediated platelet aggregation. Furthermore, plasma levels of betathrombo-globulin and platelet factor 4 remained unchanged. Peripheral hemodynamic parameters were also studied. The peripheral blood flow was measured using a Doppler ultrasound; the pain free walking distance and the total walking ability distance were determined under standardized conditions on a treadmill. These last two parameters show a trend to improvement which nevertheless was not statistically significant. All together these results encourage further in vivo studies using BAY U3405 or related compounds on a long-term administration.

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