Thirty patients took part in a double-blind trial to compare morphine 10 mg i.m. with morphine 5 mg into the extradural space for pain relief following Caesarean section. With the extradural route the mean time to first analgesia was 7.95 h compared with 4.75 h for the i.m. route. The mean number of further doses of diamorphine 7.5 mg required for pain relief in the first 24 h was 1.93 (+/- 0.3...

Sir,—A 10-yr-old girl with scoliosis underwent corrective surgery during general anaesthesia combined with a continuous thoracic extradural. During surgery she received extradural fentanyl 4 g ml 1 which was continued after operation. Anaesthesia and surgery were uneventful. After operation the extradural infusion was set at 2–6 ml h 1 and she had satisfactory pain control. On the third day aft...

We report the use of extradural diamorphine for postoperative analgesia as a nurse-based service on selected surgical wards in a district general hospital. Eight hundred patients received lumbar or thoracic extradural diamorphine analgesia for postoperative or traumatic pain. Diamorphine was administered in bolus form by suitably trained nursing staff. Satisfactory analgesia, recorded on a verb...

BACKGROUND Previous studies suggest that caudal administration of ketamine cause effective analgesia. The purpose of the current study was to compare the clinical effectiveness and plasma concentrations of S(+)-ketamine after caudal or intramuscular administration in children to distinguish between local and systemic analgesia. METHODS After induction of general anesthesia, 42 patients, aged ...

Pulmonary gas distribution, functional residual capacity (FRC), closing capacity (CC), arterial oxygen tension (PaO2) and alveolar-arterial oxygen tension gradient (PAO2-PAO2) were measured in seven subjects before and after the induction of extradural analgesia for routine surgery. It was found that pulmonary gas distribution was within normal limits throughout the study, although there were t...

5. Mallett SV, RoUes K, Cox D, Burroughs A, Hunt B. Intraopcrative use of aprotinin (Trasylol) in orthotopic liver transplantation. Transplantation Proceedings 1991; 23: 19311932. 6. Thomson JF, Roath OS, Francis JL, Webster JHM, Chant ADB. Aprotinin in peripheral vascular surgery. Lancet 1990; 335:911. 7. Kobrinsky NL, Letts MR, Patcl LR, l-Desamino-8-D arginine vasopressine (Desmopressin) dec...

Sir,—We are grateful for the opportunity to reply to the letter from Drs Jones and Nixon, comparing the results of their audit of postoperative extradural analgesia with our own published results. It would appear from the results of Dr Jones and colleagues that the use of extradural fentanyl—bupivacaine mixtures was associated with less hypotension and better pain relief than the diamorphine-bu...

Arterial oxygen saturation (SaO2) was analysed continuously before and for 24 h after lower abdominal surgery in 30 patients breathing air using one of three postoperative analgesic regimens: i.v. diamorphine using a patient-controlled analgesia system (PCAS), extradural diamorphine or i.m. morphine. Hypoxaemia was defined as SaO2 less than 94% for more than 6 min h-1. Before operation there wa...

We have studied the use of clonidine combined with low doses of sufentanil and bupivacaine in 45 parturients requiring extradural analgesia for the first stage of labour, in a double-blind, randomized study. We gave 0.0625% bupivacaine 10 ml containing 1:200,000 adrenaline and sufentanil 10 micrograms (1 ml) to which was added 0.9% saline, or clonidine 100 or 150 micrograms (1 ml). We compared ...

Sir,—Morris has suggested [1] that removal of a fixed extradural catheter may be facilitated by placing the patient in the original insertion position. I recently experienced a case where this recommendation was unhelpful. I was asked to assess a 73-yr-old patient who appeared to have an obstructed extradural catheter after a total hip replacement. The extradural space had been identified earli...