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Biomedical subjects

V Dahl

Publications and source records attributed to V Dahl.

At least 19 recordsLinked to original sources
PubMed2006

Does esomeprazole prevent post-operative nausea and vomiting?

BACKGROUND: Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esomeprazole on reducing post-operative nausea and vomiting (PONV). METHODS: Patients undergoing laparoscopic or open gynaecological surgery, or laparoscopic cholecystectomy were randomized to receive three peri-operative doses double blindly of either esomeprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen including fentanyl and sevoflurane/nitrous oxide. RESULTS: The study population consisted of 284 patients. Demographic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0-24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24-h incidence of PONV was 63% after laparoscopic gynaecology, 80% after laparoscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the lowest risk when corrected for other risk factors of PONV. CONCLUSION: Esomeprazole had no clinically relevant effect on the overall 24-h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24-h post-operatively. This may be of value in patients with an increased risk of pulmonary aspiration.

Adult↗
PubMed2004

Ibuprofen vs. acetaminophen vs. ibuprofen and acetaminophen after arthroscopically assisted anterior cruciate ligament reconstruction.

BACKGROUND AND OBJECTIVE: The analgesic potency of non-steroidal anti-inflammatory drugs and acetaminophen are still being debated. We have assessed the relative analgesic effect of ibuprofen, acetaminophen or the combination of both after orthopaedic surgery. METHODS: Sixty-one ASA I patients, scheduled for an elective anterior cruciate ligament reconstruction under general anaesthesia were randomized, in a double blind fashion, into one of three groups. The ibuprofen group (n = 17) received ibuprofen 800 mg orally 1 h before operation and again at 6 and 12 h after the initial dose. The acetaminophen group (n = 20) received of acetaminophen 1 g orally at the same time intervals. The combination group (n = 24) received both ibuprofen 800 mg and acetaminophen 1 g. Surgery was performed under general anaesthesia with propofol and fentanyl for induction and maintenance with propofol and nitrous oxide in oxygen. The patients were monitored for 24 h thereafter, and the following variables were assessed: pain by visual analogue and verbal scales, need for rescue intravenous opioid analgesia (i.e. ketobemidone) and adverse events. RESULTS: The ibuprofen group and the combination group experienced significantly less pain during the first 6 h after surgery than the acetaminophen group using the visual analogue and the verbal scales. The acetaminophen group also had a significantly higher average consumption of opioids during the first 6 and 24 h. There were no significant differences between the ibuprofen group and the combination group in respect of experienced pain or consumption of rescue analgesia. The incidence of side-effects, postoperative haemoglobin concentration and renal function, judged by creatinine clearance, were identical between the groups. CONCLUSION: Ibuprofen 800 mg thrice daily reduced pain to a greater degree than acetaminophen 1 g thrice daily, after anterior cruciate ligament reconstruction under general anaesthesia. The combination of acetaminophen and ibuprofen did not provide any superior analgesic effect.

Acetaminophen↗
PubMed2002

High-dose diclofenac for postoperative analgesia after elective caesarean section in regional anaesthesia.

Although the use of non-steroidal anti-inflammatory drugs (NSAIDs) is well established in the postoperative setting, their use after caesarean sections is still controversial. In a randomised, double-blinded, placebo controlled study we have estimated the opioid-sparing effect of diclofenac suppositories after elective caesarean sections in spinal anaesthesia. Eighty-two women ASA class I or II scheduled for caesarean section were randomised to receive either diclofenac suppositories 100 mg or placebo every 12 h after the operation. The diclofenac group (n = 40) consumed significantly less morphine in the postoperative period (14.0 +/- 1.5 mg in 32 h) compared with the placebo group (21.5 +/- 1.6 mg in 32 h, P < 0.05). The average level of postoperative pain as estimated by a visual analogue scale (VAS) and a verbal scale tended to be lower in the diclofenac group, but this was not significant. There were no differences in demographic data, perioperative bleeding, side-effects or discharge time between the groups. Diclofenac suppositories 100 mg given twice daily after caesarean section are opioid sparing.

Clinical Trial↗
PubMed2001

[Is the epidural analgesia to blame when it comes to neurological complications following labor?].

BACKGROUND: One of every four parturient in Norway receives epidural analgesia during labour. Even though epidural analgesia is considered very safe, there is a tendency to blame the epidural whenever there are neurological complications after labour. METHODS: This paper presents a case report on a woman who developed femoral mononeuropathy after labour. The various neurological complications after labour are discussed. DISCUSSION: Gynaecologists, neurologists, mid-wives and even anaesthesiologists seem unaware of the fact that the incidence of neurological complications are four to five times higher as a result of the labour per se than complications caused by the epidural. Peripheral neurological symptoms after labour occur in 1:2-3,000 labours. Postpartum drop-foot and femoral mononeuropathy are the most frequent complications. Half of all parturients will experience low back pain during pregnancy and/or labour, and one in four will complain of headache in the immediate postpartum period. Urinary bladder dysfunction after pregnancy is not uncommon, but the incidence is the same among mothers who have received epidural analgesia and those who have not. Complications after epidural analgesia, such as haematoma, abscesses and direct nerve damage are extremely rare, but need immediate treatment.

Adult↗
PubMed2000

Non-opioid postoperative analgesia.

Although significant improvement has been made in the treatment of pain in the postoperative period, many patients still experience unnecessary discomfort resulting in distress, higher morbidity and prolonged stay in hospital. The standard pillar of postoperative treatment of severe pain is the use of opioids. However, adverse reactions to opioids make their use unfavourable. A better understanding of the pathophysiology of pain has helped clinicians to a more balanced approach to postoperative pain treatment. The development of the multimodal approach to postoperative analgesia, with the use of different drugs acting via different routes to give good analgesia, with minimal side-effects, represents a major development in the treatment of postoperative pain. Early, aggressive mobilisation and feeding must follow in order to restore normal conditions quickly. Alternatives to opioids should be used as extensively as possible. Local anaesthesia, used as regional blocks or as wound infiltration, is most beneficial. Paracetamol has good basic analgesic properties, and should probably be used in dosages higher than recommended today. The combination with a NSAID results in better and longer-lasting analgesia. The intravenous form propacetamol will increase the possibilities of its use. The new concept of selective COX-2 inhibiting NSAIDs will result in analgesic and anti-inflammatory drugs with fewer side-effects. The well-known inexpensive group of corticosteroids have good analgesic and anti-emetic properties, and are especially interesting to use in patients who do not tolerate NSAIDs. The alpha2-receptor agonists like clonidine, when administered epidurally or intrathecally, are useful adjuncts, but their adverse effects on sedation and hypotension limit their use. NMDA-receptor antagonists are of limited value in the postoperative period. Adenosine and neostigimine are still on a research level but may lead to new, clinically useful analgesic drugs. In the future, cannabinoids, cholecystokinin-receptor antagonists and neurokinin-1 antagonists may become important analgesic drugs.

Acetaminophen↗
PubMed2000

No effect of preoperative paracetamol and codeine suppositories for pain after termination of pregnancies in general anaesthesia.

Outpatient surgery demands rapid recovery and satisfied patients. The purpose of the study was to investigate whether rectal premedication with paracetamol and codeine would reduce the need of rescue analgesics, reduce the postoperative pain experience and result in faster eligibility for discharge. Ninety pregnant patients scheduled for day-case surgery with evacuation of the uterine cavity were randomly assigned into two groups. The paracetamol and codeine group was given a suppository with 60 mg of codeine and 800 mg of paracetamol together with standard premedication of intramuscular midazolam 0.08 mg/kg. The placebo group was given a placebo suppository and midazolam. All patients underwent the surgical procedure under general anaesthesia with alfentanil 15 microg/kg and propofol 1.5-2 mg/kg. There were no statistically significant differences between the groups in the postoperative pain experience as judged by Visual Analogue Scale (VAS-scale), verbal scale or the need for rescue analgesic medication with ketobemidone. Most of the patients experienced little postoperative pain with more than 70% scoring less than 20 mm on a VAS-scale from 0-100 mm at any time during the postoperative period. The paracetamol and codeine patients were significantly more sleepy at 30 min postoperatively. There were no differences between the groups in postoperative nausea or vomiting and no difference in discharge eligibility. The use of pre-operative suppository with paracetamol 800 mg and codeine 60 mg is unnecessary in this group of patients.

Abortion, Induced↗
PubMed2000

Does ketamine have preemptive effects in women undergoing abdominal hysterectomy procedures?

UNLABELLED: Ketamine may produce "preemptive" analgesia when administered before surgically induced trauma. Therefore, we hypothesized that pre- versus postincisional administration of ketamine would improve pain control after abdominal hysterectomy procedures. Eighty-nine patients were randomly assigned to one of three treatment groups according to a placebo-controlled, double-blinded protocol: Group 1 (placebo) received saline 0.04 mL/kg IV immediately before and after surgery; Group 2 (preincision), received ketamine 0.4 mg/kg IV before skin incision and saline at the end of the operation; and Group 3 (postincision), received saline before skin incision, and ketamine 0.4 mg/kg IV was given after skin closure. The general anesthetic technique was standardized in all three treatment groups. During the first postoperative hour, Group 3 experienced significantly less pain than Groups 1 and 2, as assessed by using both visual analog and verbal rating scales. There were no significant differences between Groups 1 and 2 with respect to pain scores, postoperative opioid analgesic requirements, and incidence of postoperative nausea and vomiting. We conclude that a single dose of ketamine 0.4 mg/kg IV fails to produce preemptive analgesic effects. IMPLICATIONS: Even though ketamine 0.4 mg/kg IV has short-lasting acute analgesic effects, it failed to produce a preemptive effect when given before abdominal hysterectomy procedures.

Adult↗
PubMed1999

Bupivacaine 2.5 mg/ml versus bupivacaine 0.625 mg/ml and sufentanil l microg/ml with or without epinephrine 1 microg/ml for epidural analgesia in labour.

We have compared three different methods of epidural analgesia in labour, bupivacaine 2.5 mg/ml (group B), bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml (group BS) and bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml + epinephrine 1 microg/ml (group BSE). One hundred and forty parturients with a singleton fetus with cephalic presentation were randomly allocated to one of the three groups. Group BSE had significantly less pain than groups B and BS. Group B had a significantly higher degree of motor blockade assessed on the Bromage scale. Significantly, more women in group B required urinary bladder catheterization than in the two other groups and they also had significantly less urge to push during active delivery. The incidence of mild pruritus was 18% in group BS and 36% in group BSE. The frequency of instrumental delivery and caesarean section was low (12% and 6.4%, respectively) with no significant differences between the groups. All women were highly satisfied with the method of analgesia and 97% would prefer the same kind of pain alleviation at the next delivery. We conclude that epidural analgesia with low-dose bupivacaine and sufentanil is as good an analgesic method as high-dose bupivacaine. Addition of low-dose epinephrine improves the analgesia.

Clinical Trial↗
PubMed1998

[Obstetric analgesia in Norwegian hospitals].

We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%. Epidural analgesia was much more widely used in university and regional hospitals than in local hospitals (p < 0.001). Five of the local hospitals did not offer epidural analgesia during labour at all. The combination of low-dose local anaesthetic and an opioid (either sufentanil or fentanyl) had not been introduced in nine of the hospitals (20%). The optimal use of epidural analgesia to relieve labour pain was judged to be more frequent by the anaesthetists than by the midwives (19% versus 11%, p < 0.01). In response to what factors limited the frequency of epidural analgesia, the anaesthetists specified factors related to the attitude of the midwife, and the midwives specified factors related to the anaesthetist. Only five of the hospitals provided written information on the various analgesic methods that could be employed during labour. The majority of midwives considered the analgesic methods employed on their maternity ward to be good or excellent. The frequency of Caesarean section was 12%; spinal anaesthesia was used in 55%, epidural anaesthesia in 17%, and general anaesthesia in 28% of the cases.

Analgesia, Epidural↗
PubMed1997

No analgesic effect of ibuprofen or paracetamol vs placebo for hysterectomies.

The aim of the present study was to evaluate the postoperative opioid-sparing effect of a pre-operative nonsteroidal anti-inflammatory drug (NSAID) (ibuprofen) vs paracetamol in a prospective, double-blind, placebo-controlled study. It was also investigated whether the use of ibuprofen or paracetamol would influence the amount of surgical bleeding. Sixty-six women scheduled for elective open hysterectomy were randomized into one of three groups. All patients received premedication (diazepam 10 mg) and test drugs orally 1 h before the start of anaesthesia: Group 1 (n=23) received 800 mg ibuprofen; Group 2 (n=22) received 1000 mg paracetamol; and Group 3 (n=21) received placebo. General anaesthesia was given with thiopentone-fentanyl-atracurium induction, and maintained with nitrous oxide-isoflurane. Postoperatively, the patients were evaluated hourly during the recovery period, and 1 and 4 days after the procedure. Postoperative pain was measured by visual analogue scale (VAS), verbal pain score and the need of standardized opioid rescue medication. Intra-operative bleeding was measured, as well as reduction in blood haemoglobin content 24 h and 4 days after the procedure. No differences were found between the groups in postoperative pain measured by any variable or opioid consumption at any time. The amount of surgical bleeding was equal in the three groups. Ibuprofen or paracetamol given pre-operatively to hysterectomy patients do not have a postoperative analgesic or opioid-sparing effect. Perioperative surgical bleeding is not influenced by these drugs.

Clinical Trial↗
PubMed1997

Spinal, epidural or propofol anaesthesia for out-patient knee arthroscopy?

BACKGROUND: We have compared three different methods of anaesthesia for out-patient knee arthroscopy in terms of perioperative conditions, postoperative pain, time taken and economy. METHODS: 91 ASA I-II patients scheduled for elective knee arthroscopy were included. After premedication with diazepam 10 mg and naproxene 500 mg orally, they were randomly assigned into one of three groups: Group S (n=32) received spinal anaesthesia with lidocaine 50 mg/ml 1.5-2 ml in 7.5% glucose through a 27-G Quincke needle, Group E (n=29) received epidural anaesthesia with mepivacaine 20 mg/ml and epinephrine 5 microg/ml, 15-20 ml, and Group P (n=30) received propofol anaesthesia with a bolus induction of 2 mg/kg followed by infusion. RESULTS: The time from start of anaesthesia until start of operation was significantly less in Group P than in the two other Groups: 7.4+/-5.4 min as compared to 23.0+/-4.8 min in Group S and 31.0+/-9.1 min in Group E (mean+/-SD, P<0.05). After end of surgery, the duration of the postoperative regional block was 75+/-28 min in Group S and 125+/-79 min in Group E (P<0.05). In Group S and Group E the postoperative pain was significantly less than in Group P at admission to the recovery unit and 60, 120 and 180 min later (P<0.05). The overall incidence of post-operative nausea or vomiting was less than 5% with no differences between the groups. One patient in Group E had block failure and one patient in Group S had a post-spinal headache. The perioperative costs of drugs and disposables were highest in Group P (30 USD) and lowest in Group S (6.5 USD). CONCLUSION: Propofol anaesthesia results in the shortest stay in the operation theatre but a higher degree of postoperative pain and a higher cost of drugs and disposables.

Adolescent↗
PubMed1996

Pre-emptive effect of pre-incisional versus post-incisional infiltration of local anaesthesia on children undergoing hernioplasty.

BACKGROUND: Although promising in experimental studies of post-traumatic pain, the concept of pre-emptive analgesia is still controversial in a clinical setting. Thus, we wanted to compare the clinical efficacy of wound infiltration with local anaesthesia before surgery with wound infiltration after hernioplasty in children. METHODS: Fifty children aged 2-10 years scheduled for hernioplasty were randomly assigned into two groups. Group 1 (n = 28) was infiltrated before surgery with bupivacaine 2.5mg/ml, 1mg/kg after induction of general anaesthesia. After surgery they were infiltrated with the same volume of 0.9% saline. Group 2 (n = 22) was infiltrated with 0.9% saline before surgery and bupivacaine 2.5 mg/ml, 1mg/kg after surgery. The study was performed double-blindly. In both groups anaesthesia was induced with thiopenthone and maintained with nitrous oxide and halothane, adjusted to keep haemodynamic measurements stable. All children were given paracetamol 15-20 mg/kg rectally when admitted to the recovery ward. Painscore (OPS) and analgesic requirements were registered postoperatively. After 48 h the parents completed a standardised questionnaire and they were interviewed by telephone after one week. RESULTS: The pre-incisional group needed significantly less halothane during the procedure compared with the post-incisional group (P < 0.05). The pre-incisional group also had a tendency towards faster awakening after the end of anaesthesia and a significantly lower OPS-pain score 30 min after the operation (P < 0.03). There were no differences between the two groups regarding need for additional analgesia: meperidine i.v. during the first 5 h postoperatively, and paracetamol thereafter. There were no differences between the groups regarding activity level, appetite and quality of sleep in the first week. In both groups the need for opioid analgesics was low: 54% in the pre-incisional group and 45% in the post-incisional group did not receive any opioid analgesic treatment. The children were virtually fully recovered after the first 24 h. CONCLUSION: Perioperative infiltration with a local anaesthetic in children undergoing hernioplasty results in a smooth recovery with little need for opioids postoperatively. Apart from a lower anaesthetic requirement and a reduced postoperative pain level after 30 min in the pre-incisional bupivacaine group, there was no difference between infiltration before (pre-emptive) or after surgery.

Analgesia↗
PubMed1995

[Combination of low molecular weight heparin and non-steroidal anti-inflammatory agents].

Non-steroidal anti-inflammatory drugs (NSAIDs) play an important part in postoperative relief of pain. Non-steroidal anti-inflammatory drugs and paracetamol should act as non-opioid basis analgesics in the postoperative period, leading to reduced need of opioid analgesia. This is beneficial, since it may reduce possible dosage-dependent side-effects of opioids such as nausea, tiredness and respiratory depression. The inhibition of prostaglandin synthesis by non-steroidal anti-inflammatory drugs also affects haemostasis, and the combination of these drugs with prophylaxis against postoperative thrombosis with heparin is controversial. We refer to a case history which illustrates this controversy. We also discuss the effect of non-steroidal anti-inflammatory drugs on pain and inflammation. Possible side-effects of these drugs and their interaction with heparin are reviewed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Prophylactic oral ibuprofen or ibuprofen-codeine versus placebo for postoperative pain after primary hip arthroplasty.

The postoperative analgesic effect of ibuprofen was compared with a combination of ibuprofen and codeine versus placebo. The study was prospective, randomized, double blind with 123 consecutive hip arthroplasty operations. All the patients received oral diazepam as premedication and spinal anaesthesia with bupivacaine 5 mg/ml 3-4 ml. Postoperatively, when the spinal anaesthesia started to wear off, the patients were randomly assigned to one of three groups; the ibuprofen group (n = 48) received 800 mg of ibuprofen orally. The ibuprofen/codeine group (IC, n = 48) received 800 mg of ibuprofen combined with 60 mg of codeine. The placebo group (P, n = 25), received oral placebo medication. The patients were observed for the need of additional opioid (e.g. ketobemidone), pain score (verbal and VAS), bleeding and side effects for five hours. The patients in the placebo group (P) had significantly higher pain scores (P < 0.05) compared with the two other groups after 2 and 4 hours, with no significant differences after 1, 3 and 5 hours. The P group also received 45% more opioids (P < 0.001) compared with the two other groups during the same period. No significant differences in bleeding or side-effects were observed between the groups. There were no significant differences between the ibuprofen group and the ibuprofen/codeine group. We conclude that a prophylactic dose of 800 mg ibuprofen orally has an opioid sparing effect with a tendency of less pain experience during the first hours after hip arthroplasty.

Administration, Oral↗
PubMed1991

[Sterile water papulae for analgesia during labor].

In a group of Scandinavian women in labour, application of sterile water wheals intradermally was compared with a "dry needling" technique as a way of treating labour pain. 101 women received intradermal wheals, 50 were "dry needled" and 117 served as a control group for perinatal complications. 57.6% of the women in the wheal group experienced more than 50% relief of pain compared with 18% in the dry needling group (p less than 0.0001). Mean duration of pain relief was 79 +/- 15 min. (SD) in the wheal group and only 19 +/- 15 min. in the dry needling group. The duration was longest if the wheals were applied early in labour. Judged by the mean Apgar scores one and five minutes after delivery, the method did not seem to have any side effects, either on the mother or on the foetus. It was impossible to carry out the study double blind, but it still strongly indicates that application of small amounts of sterile water intradermally during labour is an efficient and safe way of reducing pain in labour.

Analgesia, Obstetrical↗
PubMed1990

[Gram positive septicemia].

There seems to be an increase in septicemia and the development of shock after infection by streptococci. Early diagnosis of serious streptococceal infection and intensive care of this group patients might prevent the onset of septic shock with its high morbidity and mortality. We illustrate the pathogenesis of serious streptococceal infection by three case reports, and discuss the pathophysiology and treatment of this serious infection.

Adolescent↗
PubMed1990

A 30-year follow-up study of a child psychiatric clientele. I. Demographic description.

A register investigation was carried out as of December 31, 1980, with the aim of giving a broad description of a child psychiatric clientele 30 years after admission to hospital. The material consists of 322 patients--189 boys (59%) and 133 girls (41%)--who were admitted during the period 1949-1951 to the only 2 child psychiatric departments at that time in Denmark. We succeeded in identifying 93% of the patients. The mean age at the time of analysis was 38.6 years (range 32-46). The material was compared with the age-related Danish population by marital status, vocational education, and socioeconomic class. A total of 115 patients (36%) had been admitted to an adult psychiatric department, and 50 patients only once. A total of 95 patients (30%) had committed criminal offences and 12 had only committed traffic offences. A total of 60 patients (19%) had obtained disability pensions. During the 30-year follow-up period, 19 patients (6%) had died. A statistically significant extra mortality was found only for women. Four patients had committed suicide. By logistic regression analysis, a statistically significant correlation was found between criminal record and admission to psychiatric department and the variables: divorce, no vocational education, and lowest socioeconomic class. About 54% had managed well, judging by the variables employed.

Adult↗