piperidines and ketobemidone

To investigate if early extubation, 2 hours after surgery, would result in more postoperative pain or in an increased use of opioid analgesics compared with late extubation, 6 hours after surgery.. Prospective, randomized study.. Intensive care unit, university hospital.. Sixty patients undergoing cardiac surgery with cardiopulmonary bypass.. Patients were randomized into 2 groups: extubation at about 2 (early) or 6 (late) hours. Anesthesia was based on propofol and remifentanil. There was no epidural analgesia and no local anesthesia in the wound. A bolus of the opioid ketobemidone was administered toward the end of surgery followed by a continuous infusion.. Pain, provoked during deep breathing or coughing, evaluated with a visual analog scale (VAS) going from 0 to 10, was measured after extubation, and at 8 and 16 hours after surgery. Unprovoked pain was measured hourly. If VAS was greater than 3, the infusion rate was increased and a bolus of ketobemidone was given. Three patients in the late group were excluded because of incomplete data. Pain did not differ between the early and late groups at any time. In all patients, 21 never scored >3, 11 scored >3 once, and 25 scored >3 more than once. Nine patients had 1 score >5. The amount of ketobemidone was similar in both groups.. Early extubation had no negative effect on the quality of postoperative pain control and was not followed by an increased use of analgesics.

Topics: Analgesics, Opioid; Analysis of Variance; Anesthetics, Intravenous; Blood Gas Analysis; Blood Pressure; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Dose-Response Relationship, Drug; Female; Humans; Intubation, Intratracheal; Length of Stay; Male; Meperidine; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piperidines; Postoperative Care; Propofol; Prospective Studies; Remifentanil; Time Factors

The incidence of nausea in relation to pain was recorded in 104 patients after abdominal operations. Ten per cent of the patients had episodes of nausea not related to pain. One hundred and fourteen episodes of concomitant pain and nausea were recorded in 61 patients (58.6 per cent). The intravenous injection of morphine or ketobemidone relieved nausea as well as pain in 80 per cent of the episodes. Relief of pain with persistence of nausea was uncommon and if pain relief was inadequate nausea was unabated. Nausea was provoked by 3.4 per cent of the morphine injections, but all patients tolerated similar doses of morphine on other occasions without nausea. Nausea often accompanies pain in the early postoperative period and can be relieved concomitant with the pain by the intravenous use of opiates in adequate doses in a high proportion of cases.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Female; Humans; Male; Meperidine; Middle Aged; Morphine; Nausea; Pain, Postoperative; Piperidines

Topics: Analgesics; Biphenyl Compounds; Humans; Meperidine; Methadone; Parasympatholytics; Piperidines