The impact of a transversus abdominis plane block including clonidine vs. intrathecal morphine on nausea and vomiting after caesarean section: A randomised controlled trial

BACKGROUND Intrathecal morphine (ITM) is a widely used technique for postcaesarean section analgesia but entails a high risk of postoperative nausea and vomiting (PONV). The transversus abdominis plane (TAP) block is an alternative. OBJECTIVE We tested the hypothesis that a TAP block including clonidine reduces the incidence of PONV after caesarean section when compared with ITM. DESIGN A randomised, controlled, double-blinded study. SETTING Geneva University Hospitals, Switzerland, from October 2013 to February 2017. PATIENTS A total of 182 patients undergoing elective caesarean section were studied. Reasons for noninclusion were complicated pregnancy, contraindication to spinal anaesthesia or TAP block, extreme weight or height, allergy to any medication or previous median abdominal incision. INTERVENTIONS Patients were allocated randomly to one of two groups (quadruple blinded): 100 μg of morphine added to the spinal local anaesthetic or a bilateral TAP block with 20 ml of ropivacaine 0.375% + 75 μg of clonidine on each side. MAIN OUTCOME MEASURES The primary outcome measure was the total number of patients presenting with PONV at 24 h. Secondary aims were to compare other adverse effects (pruritus, respiratory depression, hypotension, bradycardia, sedation), analgesic efficacy and the quality of postoperative recovery. RESULTS At 24 h, there was no significant difference between ITM and TAP groups in the total number of patients ...
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Postoperative nausea and vomiting Source Type: research

Related Links:

ABSTRACT OBJECTIVE To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil ’ s national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil ®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The imp...
Source: Revista de Saude Publica - Category: International Medicine & Public Health Source Type: research
CONCLUSIONS Antepartum peregrination suffers interference from the mother ’ s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.RESUMO OBJETIVO Analisar as caracter ísticas maternas e da assistência pré-natal associadas à peregrinação no anteparto entre gestantes de um estado do Nordeste brasileiro. MÉTODOS Estudo quantitativo e transversal, com abordagens descritiva e analítica, vinculado à pesquisa Nascer em Sergipe, realizada entre junho de 2015 e abril de 2016. Foram avaliadas 768 puérpera...
Source: Revista de Saude Publica - Category: International Medicine & Public Health Source Type: research
Hello, I am a current fellow. I have been talking with a group (PMR) and they are asking me to take call. I don't know exactly how this works from a monetary standpoint and I was hoping someone could fill me in. It is 1:4 call and it is a week on at a time. Rounding Sat and Sun on a unit of around 10-12. I am assuming I don't get paid for taking call at night which means I will only make what I bill on the weekends. Is that correct? If there is anyone who has done this as a PMR doc does this... Advice on Taking Call
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Pain Medicine Source Type: forums
In reviewing the content outline for the OSCE, all of the sections make sense except for the ethics one. It just seems like a laundry list of potential ethical issues in no particular order, and I can't imagine what the graders will want me to demonstrate in the standardized patient interaction. Without violating any confidentiality agreements with the ABA, can anyone help give me some idea of what to expect? I... Ethics OSCE
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums
I know how everyone feels about these huge AMCs, but unfortunately they seem to have control over certain locations/markets. I've heard a few people say USAP is one of the "less evil" AMCs. Just wondering, if you were forced to take a job with an AMC such as USAP, would you even roll the dice and enter the partnership track? Or would you strictly take an employed job with them with set hours/call, with no chance of partnership. I say partnership, realizing that there is no "true... USAP - Partner track worth it?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums
Conclusion: Hypothetical risk factors for obstruction of the vermifor m appendix detected on CT were not associated with acute appendicitis. That suggests that factors other than those related to mechanical obstruction are implicated in the pathogenesis of acute appendicitis.Resumo Objetivo: Avaliar a correla ção de critérios morfológicos do apêndice cecal por tomografia computadorizada (TC) e o risco de apendicite aguda. Materiais e Métodos: Casos foram definidos como apendicite aguda confirmada cirurgicamente que tiveram pelo menos dois exames de TC: um no diagnóstico de ap...
Source: Radiologia Brasileira - Category: Radiology Source Type: research
Abstract Objective: To determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI). Materials and Methods: Case-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI. Results: Final sample comprised 50 patients submitted to unilateral MRI of the hip...
Source: Radiologia Brasileira - Category: Radiology Source Type: research
Conclusion The results obtained from this research shows, in general, the fragility in the social and political infrastructure necessary to improve the living conditions of populations, particularly those that depend on family agriculture in drought prone areas. The conditions of social, economic and environmental vulnerabilities presented in the region can be amplified by the drought process, and can aggravate the impacts resulting drought events, thus disadvantaging the population of this region, as shown in the Fig. 1. The general perception of the interviewees of the health sector shows an agreement with what is found...
Source: PLOS Currents Disasters - Category: International Medicine & Public Health Authors: Source Type: research
View Original Article Here: How Long Does Shingles Last In The Elderly? Shingles is a viral infection that follows a varicella-zoster infection, although it can take decades for symptoms of the secondary disease to emerge. The condition presents as a painful and blistering rash, but it is not life-threatening. According to the Center for Disease Control, there are nearly one million cases in the United States each year, and almost half of those cases are in older adults over age 60. Some people only see one instance of the illness, while others have recurring symptoms, but 30 percent of Americans will develop shingles at s...
Source: Shield My Senior - Category: Geriatrics Authors: Tags: Senior Safety Source Type: blogs
So much of American medicine focuses on treating the illness, rather than the whole person. Oftentimes, it seems easier to throw medicine at a cough or a cold, without exploring further to make sure the cough isn't a result of a chronic post-nasal drip because of allergy or sinus issues. If you're tired of treating symptoms to make a condition better, rather than treating the condition as part of your whole body, you're not alone. The latest data from the National Center for Complementary and Integrative Health (NCCIH) shows 4 of 10 adults and 1 in nine children are using some form of complementary medicine. This is not t...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
More News: Allergy | Allergy & Immunology | Anesthesia | Anesthesiology | Back Pain | Clonidine | Depression | Hospitals | Morphine | Pain | Pregnancy | Respiratory Medicine | Study | Switzerland Health