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Biomedical subjects

S S Reuben

Publications and source records attributed to S S Reuben.

43 records · Page 3Linked to original sources
PubMedDate not supplied

Ketorolac as an adjunct to patient-controlled morphine in postoperative spine surgery patients.

BACKGROUND AND OBJECTIVES: This randomized double-blind study was designed to determine whether administration of ketorolac either on schedule or as a component of patient-controlled analgesia (PCA) to patients who have undergone spinal stabilization would decrease PCA morphine use, decrease side effects, and/or enhance analgesia. METHODS: Eighty inpatients undergoing spine stabilization by one surgeon were evaluated after excluding patients with contraindications to the use of ketorolac or morphine. All patients received PCA morphine. The patients were divided into four groups, which were given either intravenous saline (control group); intravenous ketorolac 15 mg every 6 hours; intravenous ketorolac 30 mg every 6 hours; or ketorolac added to the PCA morphine on a milligram per milligram basis. The outcome measures included pain scores. 24-hour morphine use, level of sedation, and side effect profile at six times during the first 24 postoperative hours. RESULTS: The total dose of morphine (P < .0001) and the cumulative doses for each of the six time periods (P varied between .02 and .0001 for the six time periods) were significantly higher in the control group than in the other three groups. There were no differences in doses administered by the other three groups. The pain scores were also significantly higher in the control group than in the other three groups, with no differences in pain scores among the other three. The sedation scores were higher (ie, patients more sedated) in the control group than in the other three groups at two of the six time periods (periods I and 6; P < .001). CONCLUSIONS: Ketorolac should be as a component of the PCA morphine in patients undergoing spine stabilization surgery. This results in decreased morphine consumption, decreased somnolence, and enhanced analgesia in comparison with patients who do not receive ketorolac.

Adult↗
PubMedDate not supplied

Use of clonidine in hernia patients: intramuscular versus surgical site.

BACKGROUND AND OBJECTIVES: This study was designed to determine if administration of clonidine in hernia patients enhances analgesia. It was also designed to determine whether administration directly in the surgical site further improves the analgesia. METHODS: A randomized, double-blinded study was undertaken at a tertiary care hospital. Forty-five outpatients undergoing unilateral inguinal hernia repair by one of two surgeons (D.P. or M.A.) under local anesthesia with monitored anesthesia care were evaluated. Patients were invited to participate in this investigation at the time of the preoperative surgical visit. Patients who had a contraindication to the use of clonidine or who refused repair under local anesthesia with sedation were excluded. Patients were randomized to one of three groups: (a) clonidine 0.5 microg/kg intramuscularly and saline in the surgical site (mixed with the local anesthetic); (b) clonidine 0.5 microg/kg in the surgical site and saline intramuscularly; or (c) saline in both the surgical site and intramuscularly. The outcome measures included visual analog pain scores twice in the hospital, pain scores at rest and with movement 24 hours postoperatively, the time to first analgesic, and total analgesic requirement. RESULTS: The pain scores were lower in both clonidine groups at 2 hours postoperatively than in the control group (P < .03). No difference was observed with respect to the time to first analgesic, 24-hour analgesic use, or 24-hour pain scores among the groups. CONCLUSIONS: When clonidine is administered to patients undergoing hernia repair, the 2-hour pain scores are lowered. No difference was exhibited when clonidine was administered intramuscularly or directly into the hernia site.

Analgesics↗
PubMedDate not supplied

Use of clonidine as a component of the peribulbar block in patients undergoing cataract surgery.

BACKGROUND AND OBJECTIVES: This study was designed to determine whether administration of clonidine as a component of a peribulbar block enhanced analgesia increased sedation, improved akinesia, or decreased intraocular pressure. METHODS: A randomized, double-blinded study was undertaken at a University-affiliated tertiary care hospital. Forty outpatients undergoing unilateral cataract surgery by a single surgeon (J.P.) under peribulbar blockade were evaluated. Patients received either 100 microg (1 mL) clonidine or 1 mL preservative-free normal saline mixed with the local anesthetic (7 mL 1% preservative-free lidocaine). A Honan adapter was applied for 10 minutes after block placement. The outcome measures included sedation scores, intraocular pressure (IOP) before and after peribulbar block, need for supplemental block, 24-hour analgesic requirement, and patient satisfaction. RESULTS: There were no differences between groups with respect to pain, sedation, or satisfaction scores. There was no difference with respect to onset of akinesia. This study revealed no significant difference in baseline IOP and postperibulbar IOP. CONCLUSIONS: Clonidine did not alter, in any appreciable way, the perioperative course for patients undergoing cataract operations. We do not recommend clonidine as a component of a peribulbar block in patients undergoing cataract extraction operations.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Effect of clonidine on upper extremity tourniquet pain in healthy volunteers.

BACKGROUND AND OBJECTIVES: Tourniquet pain is often a limiting factor during intravenous regional anesthesia (IVRA). The purpose of this study was to evaluate the efficacy of 1 microg/kg of clonidine added to IVRA-lidocaine in decreasing the onset of severe tourniquet pain. METHODS: Upper extremity IVRA was performed in 15 volunteers with a double-cuffed tourniquet on 2 separate occasions at least 1 week apart. IVRA was established with either 40 mL 0.5% lidocaine (IVRA-L) or 40 mL 0.5% lidocaine with 1 microg/kg clonidine (IVRA-Cl). Verbal pain scores (VPS) from 0 to 10 were recorded every 5 minutes. When the VPS reached 6, the distal cuff was inflated, and the proximal cuff was deflated. This was defined as the first tourniquet time (T1). The study was terminated at a VPS of 10, or at 60 minutes, whichever occurred first. The time from distal cuff inflation to deflation was defined as the second tourniquet time (T2). Total tourniquet time (TT) was the sum of T1 and T2. RESULTS: T1 for IVRA-L (21.6 +/- 3.9) and IVRA-Cl (22.7 +/- 2.7) were not significantly different. T2 and TT were significantly longer (P < .0001; P < .0007, respectively) for IVRA-Cl (33.0 +/- 6.2; 55.6 +/- 6.6) than for IVRA-L (25.5 +/- 4.4; 47.1 +/- 5.2). CONCLUSION: This study shows that the addition of 1 microg/kg of clonidine to 40 mL of 0.5% IVRA-L delays the onset time of tourniquet pain in healthy, unsedated volunteers.

Anesthesia, Intravenous↗
PubMedDate not supplied

Comparison of wound infiltration with ketorolac versus intravenous regional anesthesia with ketorolac for postoperative analgesia following ambulatory hand surgery.

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the analgesic effectiveness of ketorolac administered with lidocaine via intravenous regional asesthesia (IVRA) or via wound infiltration following ambulatory hand surgery. METHODS: The patient population in this double-blind study consisted of 60 patients scheduled for elective ambulatory hand surgery, who were divided into three groups of 20 each. All patients received IVRA with 40 mL 0.5% lidocaine and 5 mL 1% lidocaine infiltrated into the surgical site. Group 1, the control group, received no additional medications; group 2 had 60 mg ketorolac added to the lidocaine used for IVRA; and group 3 had 60 mg ketorolac added to the lidocaine used for wound infiltration. Postoperative pain was assessed by a 10-cm visual analog scale. VAS) 1 hour and 2 hours after tourniquet deflation. In the postanesthesia care unit analgesia was provided with fentanyl until the VAS score reached 3 or lower. Patients were instructed to take one Tylenol No. 3 (acetaminophen with codeine) tablet every 4 hours as needed at home. They were contacted the next day, and the time to first additional narcotics and the total number of tablets taken were recoded. RESULTS: No differences in demographic variables or in operative, tourniquet, or discharge times were noted among the groups. The VAS scores were significantly lower in the two groups who received ketorolac than in the control group (P < .05); the mean time from tourniquet release to first medication was 109 +/- 73 minutes for group 1, 467 +/- 431 for group 2, and 393 +/- 312 for group 3 (P < .05); and the number of tablets taken was 4.1 +/- 1.3 for group 1, 1.8 +/- 1.2 for group 2, and 2.0 +/- 1.3 for group 3 (P < .05). CONCLUSION: Ketorolac provides similar postoperative analgesia after ambulatory hand surgery when administered with lidocaine either by IVRA or by wound infiltration.

Ambulatory Surgical Procedures↗