Mean Discomfort Score Research Articles

OC-082 26-Week efficacy and safety of once-daily oral linaclotide in patients with irritable bowel syndrome with constipation (IBS-C): a European perspective

IntroductionLinaclotide, a minimally absorbed guanylate cyclase-C receptor agonist, is an investigational drug treatment for IBS-C. As part of the European Medicines Authority submission we evaluated the efficacy and safety of...

PTU-152 Significant improvements in abdominal pain and bowel symptoms in a phase 3 trial of linaclotide in patients with irritable bowel syndrome with constipation (IBS-C): a European perspective

IntroductionLinaclotide, a minimally absorbed guanylate cyclase-C agonist, was evaluated in a Phase 3 trial. To fulfil EMA submission requirements, the efficacy, safety and effects of withdrawal of linaclotide 290 μg...

Analysis of Frequency, Intensity, and Interference of Discomfort in Computerized Numeric Control Machine Operations

AbstractThe introduction of Computerized Numeric Control (CNC) technology in manufacturing industries revolutionized the production process a few decades back. There are some health and safety problems associated with these machine operations, however. The main objectives of the present work is to study the health and safety issues associated with the CNC machines with respect to control and display, specifically to determine the frequency, intensity of discomfort, and its interference in operating different CNC machines as reported by the workers operating them. The postural discomfort associated with CNC machines was studied, and the frequency, intensity of discomfort, and interference of the level of discomfort with the participants' ability to work were recorded and analyzed. The study revealed that 20.5% of the operators reported discomfort 1 or 2 times, 25.4% experienced discomfort 3 to 4 times in a week, 37.7% had discomfort daily, and 16.4% reported discomfort several times a day. Discomfort was reported in all the body parts involved (lower back, neck, upper back, shoulder, and leg), but the highest discomfort scores were associated with the shoulder and arm region. Workers reporting discomfort several times a day also reported high mean discomfort scores. The study established that the frequency and intensity of the discomfort in all body parts is related to the position of the control panel and display. © 2012 Wiley Periodicals, Inc.

Accommodation and convergence during sustained computer work

Purpose With computer usage becoming almost universal in contemporary society, the reported prevalence of computer vision syndrome (CVS) is extremely high. However, the precise physiological mechanisms underlying CVS remain unclear. Although abnormal accommodation and vergence responses have been cited as being responsible for the symptoms produced, there is little objective evidence to support this claim. Accordingly, this study measured both of these oculomotor parameters during a sustained period of computer use. Methods Subjects (N = 20) were required to read text aloud from a laptop computer at a viewing distance of 50 cm for a sustained 30-minute period through their habitual refractive correction. At 2-minute intervals, the accommodative response (AR) to the computer screen was measured objectively using a Grand Seiko WAM 5500 optometer (Grand Seiko, Hiroshima, Japan). Additionally, the vergence response was assessed by measuring the associated phoria (AP), i.e., prism to eliminate fixation disparity, using a customized fixation disparity target that appeared on the computer screen. Subjects were asked to rate the degree of difficulty of the reading task on a scale from 1 to 10. Results Mean accommodation and AP values during the task were 1.07 diopters and 0.74∆ base-in (BI), respectively. The mean discomfort score was 4.9. No significant changes in accommodation or vergence were observed during the course of the 30-minute test period. There was no significant difference in the AR as a function of subjective difficulty. However, the mean AP for the subjects who reported the least and greatest discomfort during the task was 1.55∆ BI and 0, respectively ( P = 0.02). Conclusions CVS, after 30 minutes was worse in subjects exhibiting zero fixation disparity when compared with those subjects having a BI AP but does not appear to be related to differences in accommodation. A slightly reduced vergence response increases subject comfort during the task.

Same day bidirectional endoscopy- does the order of the procedures matter?

IntroductionPatients commonly have same day bidirectional endoscopy performed. There is no consensus on which order oesophagogastroduodenoscopy (OGD) and colonoscopy should be performed and how this impacts on completion rates, discomfort...

Safety of a new compact catheter for men with neurogenic bladder dysfunction: a randomised, crossover and open-labelled study

Self-catheterising males aged ≥18 years with spinal cord lesion and normal/impaired urethral sensation were enrolled in this comparative, randomised, crossover and open-labelled multicentre trial. When possible, intermittent catheterisation is the preferred method of bladder emptying for neurogenic bladder dysfunction. Hydrophilic-coated catheters have improved safety and ease of use, and a new compact catheter for men has been developed to improve discretion. Participants self-catheterised at least four times daily for 14 days with a standard or compact catheter. The primary outcome measure was discomfort, using a visual analogue scale. Non-inferiority was defined as a difference in mean discomfort score of <0.9 cm. Other assessments included ease of use, discretion and the degree of pain, stinging or resistance. A total of 36 individuals participated and 30 were included in the intention-to-treat analysis. The mean difference between catheters for participant discomfort was -0.347 cm (95% confidence intervals: -1.493, 0.800). There were significant differences (P≤0.0001) in favour of the compact catheter for disposal and discretion, and inserting, storing, carrying and controlling the catheter. Fewer participants experienced resistance with the compact catheter. Participants were less likely to touch the coated part of the compact catheter. One adverse event was reported for each catheter. The coated compact catheter is at least as acceptable to the user as the standard catheter, with no inferiority observed in the level of discomfort. Secondary endpoints suggest that there are advantages of using the compact catheter, particularly with regard to discretion and ease of use. France/Denmark.

A patient preference comparison of two fixed combinations, brinzolamide 10 mg/ml+timolol 5 mg/ml suspension and dorzolamide 20 mg/ml +timolol 5 mg/ml solution in patients with open‐angle glaucoma or ocular hypertension

Abstract Purpose To assess patient preference and comfort of Brinzolamide 10 mg/ml+Timolol 5 mg/ml Suspension (Brinz/Tim) compared to Dorzolamide 20 mg/ml+Timolol 5 mg/ml Solution (Dorz/Tim; COSOPT®) after topical ocular administration of a single drop. Methods This was a double‐masked, randomized, active‐controlled, cross‐over, multi‐center study. Patients were randomly assigned to receive a single drop in both eyes of either Brinz/Tim or Dorz/Tim on day 1 followed by a single drop of the other medication on day 2. Immediately after dosing, the patients completed an ocular discomfort assessment (on a scale of 0‐9; 0 = no discomfort; 9 = substantial discomfort). On day 2 the patients also responded to a preference question. Results Of the 129 patients enrolled, on day 1, 63 received Brinz/Tim and 66 received Dorz/Tim. Of these patients, 106 (82.2%) expressed a drop preference and met all inclusion/exclusion criteria (PP population). Brinz/Tim was preferred by 84 patients (79.2%) while 22 patients (20.8%) preferred Dorz/Tim (P &lt; 0.0001). The mean discomfort scores (± SE) were 1.5 ± 0.2 for Brinz/Tim and 3.3 ± 0.2 for Dorz/Tim. Brinz/Tim was significantly more comfortable than Dorz/Tim (P &lt; 0.05). Conclusion Brinz/Tim was preferred by more patients than Dorz/Tim. Patients also responded that Brinz/Tim was the more comfortable medication. This significant advantage in comfort may promote patients compliance with respect to the chronic use of their IOP‐lowering medication. Commercial interest

Nasal respiratory support in premature infants: short-term physiological effects and comfort assessment

To evaluate the effects of nasal respiratory support on physiologic parameters and comfort of premature infants, when compared to spontaneous breathing without nasal respiratory support. This was a prospective, randomized, controlled, cross-over clinical study. Infants were enrolled into the study when in 'stable' condition (when discontinuation of nasal respiratory support was considered appropriate). Infants were randomized to receive first 3 h of nasal respiratory support (nasal continuous positive airway pressure or nasal intermittent mandatory ventilation) or to spontaneous breathing, and then were crossed-over to the other assignment. Each infant served as his own control. Fifty-four infants were included in the study (birth-weight: 1528 +/- 545 g; gestational age: 30.5 +/- 2.7 weeks). Average values of systolic, diastolic and mean blood pressure and discomfort score were significantly higher while respiratory rate was significantly slower on nasal respiratory support compared to spontaneous breathing. Heart rate was comparable on both modes. Nasal respiratory support in 'stable' premature infants is associated with increased blood pressure and increased discomfort, despite a decreased respiratory rate. The clinical importance of these effects is modest. Medical teams should consider these effects and balance its need with its adverse effects according to the clinical condition.

Analgesic pretreatment for antibiotic skin test: vapocoolant spray vs ice cube

Objectives The objective of this study was to compare the efficacy of ethyl chloride spray and ice cube for the control of pain induced by the antibiotic skin test. Methods We performed a prospective, crossover, randomized study in which healthy adult volunteers received an intradermal skin test on both arms after different analgesic pretreatments. We assessed the pretreatment pain and discomfort after the intradermal skin injection using a 100-mm visual analogue scale. Results A total of 50 volunteers were enrolled in the study. The mean pain scores after the skin test were 32.4 ± 17.6 and 54.7 ± 22.4 mm, for the ice cube and vapocoolant spray pretreatment, respectively ( P < .0001). The mean discomfort scores during pretreatment were 20.0 ± 15.2 mm for ice cube and 10.5 ± 11.5 mm for vapocoolant spray ( P < .0001). Forty-five (90%) subjects preferred the ice cube pretreatment for the intradermal skin test. Conclusions The ice cube application was significantly more effective than the vapocoolant spray in reducing the pain of the antibiotic skin test. Hence, the ice cube pretreatment is suggested for easy and fast pain reduction for the antibiotic skin test in the emergency department.

Outpatient oesophageal–precordial electrical cardioversion of atrial fibrillation: an effective and safe technique to restore sinus rhythm

External electrical cardioversion is commonly used in the management of atrial fibrillation (AF), but usually involves general anaesthesia. We tested the efficacy, safety and tolerability of a minimally invasive cardioversion technique, not requiring general anaesthesia, performed on an outpatient basis. We performed outpatient oesophageal cardioversion in 87 consecutive patients (mean age: 67.5 +/- 9.6 years; weight: 77.47 +/- 12.34 kg; left atrium diameter: 46.25 +/- 6.85 mm; LVEF: 55.5 +/- 16%) with persistent AF (mean duration: 6.99 +/- 11.55 months). A biphasic shock was delivered via an oesophageal decapolar lead (cathode) and two precordial patches (anode) under a mild sedation (midazolam 2.5-5 mg). In the first 25 patients, a step-up protocol (from 10 to 100 J) was performed whereas, in the other 62, a first shock at 50 J and a second one at 100 J, were delivered. Patients described the level of discomfort caused by the procedure according a five-grade scale. Cardioversion was achieved in 97.7% of patients using a mean effective energy of 51.2 +/- 15.7 J. In 88.5% of patients, sinus rhythm was restored by using 50 J or less. No complications occurred and no patient required hospital admission. Mean discomfort score was 1.56 +/- 0.74 out of 5. Sinus rhythm persisted in 62.6% of patients at the 1-month follow-up. Outpatient oesophageal cardioversion is a safe, acceptable and effective way to cardiovert patients with AF. It may be a useful alternative to external cardioversion. A relatively high starting energy (50 J) was demonstrated to be superior to a low-energy step-up technique.

Does prior instillation of a topical anaesthetic alter the pupillary mydriasis produced by tropicamide (0.5%)?

It is common clinical practice to instill a topical anaesthetic prior to the instillation of a mydriatic agent into the eye. The main rationale for using the anaesthetic is to increase corneal permeability, so that more of the mydriatic agent reaches the receptor sites within the anterior chamber. It addition, as mydriatics generally cause stinging, prior use of an anaesthetic should reduce the degree of discomfort. The aim of the present study was to determine whether the efficacy of mydriasis produced by an antimuscarinic agent is enhanced by prior instillation of a topical anaesthetic. The study was performed using a double-masked protocol on 20 healthy young subjects. One drop of either proparacaine (proxymetacaine) (0.5%) or isotonic saline was instilled into the eye, followed by one drop of tropicamide (0.5%). Pupil diameter was measured using a customized photographic device at 0, 10, 20, 30 and 60 min following drug instillation. Additionally, subjects were asked to rate the degree of discomfort following the instillation of each drop on a scale from 0 (no discomfort) to 10 (agony). There was no significant difference in either the rate of onset of mydriasis, or the maximum pupil diameter achieved between the two conditions. The mean change in pupil diameter produced by tropicamide after the instillation of saline or proparacaine was 2.31 and 2.28 mm, respectively. The mean discomfort scores following instillation of saline and proparacaine were 1.15 and 1.65, respectively, while mean discomfort scores following the instillation of tropicamide after saline or proparacaine were 4.00 and 0.85, respectively. Instillation of a topical anaesthetic does significantly reduce the degree of discomfort produced by the instillation of tropicamide. However, it does not produce any significant increase in either the magnitude or rate of onset of mydriasis.

Single use of fentanyl in colonoscopy is safe and effective and significantly shortens recovery time

Colonoscopy remains an uncomfortable examination and many patients prefer to be sedated. The aim of this study was to evaluate the efficacy and safety of intravenous administration of fentanyl in titrated doses compared with intravenous administration of the well-known midazolam in titrated doses. One hundred twenty-six patients scheduled for ambulatory colonoscopy were randomly assigned to receive either 25 mcg fentanyl (Fentanyl group, n = 66, 35 females, mean age = 61.5 years) and titrated up to 50 mcg or 2 mg midazolam (Midazolam group, n = 60, 33 females, mean age = 63.2 years) and titrated up to 5 mg. Patients graded discomfort on a scale from 0 to 4 and pain on a scale from 0 to 10. Success of the procedure, time to cecum, complications, and recovery time for each patient were independently recorded. Mean discomfort scores were 0.4 in the Fentanyl group and 1.0 in the Midazolam group (p = 0.002). Similarly, mean scores for pain and anus to cecum time were lower in the Fentanyl group than in the Midazolam group [2.59 vs. 4.43 (p = 0.002) and 8.7 vs. 12.9 min (p = 0.012), respectively]. No adverse events were reported in the Fentanyl group, while in the Midazolam group a decrease in oxygen saturation was noted in 23/60 (35%) patients. Mean recovery time was 5.6 min in the Fentanyl group and 16 min in the Midazolam group (p = 0.014). Mean dosage was 36 mcg for fentanyl and 4.6 mg for midazolam. Administration of fentanyl in low incremental doses is sufficient to achieve a satisfactory level of comfort during colonoscopy.

Biphasic transoesophageal vs. transthoracic electrical cardioversion of persistent atrial fibrillation

To compare the efficacy and safety of transoesophageal (TOC) vs. transthoracic (TTC) electrical cardioversion, both with biphasic shocks, for sinus rhythm (SR) restoration in patients with persistent atrial fibrillation (AF). We randomised 210 patients (151 male, 59 female, mean age 66 +/- 9 years) with persistent AF into two groups: group 1 (n = 104) undergoing TOC with a step-up protocol of 30, 50, 70 and 100 J, and group 2 (n = 106) undergoing TTC with a step-up protocol of 70, 100, 120 and 150 J. The two groups were homogeneous as for clinical and instrumental characteristics, except for left ventricular ejection fraction (50.5 +/- 10% in group 1 vs. 53 +/- 8% in group 2, P < 0.05) and thoracic impedance (63 +/- 8 Omega in group 1 vs. 66 +/- 6 Omega in group 2, P < 0.005). SR was restored in 98 (94%) group 1 patients vs. 99 (93%) group 2 patients (P = NS). First shock was effective in 48 (46%) group 1 patients vs. 54 (51%) group 2 patients (P = NS). Mean delivered energy was 50.4 +/- 23.6 and 95.1 +/- 29.6 J; mean effective energy was 47.3 +/- 20.7 and 91.2 +/- 26.6 J in group 1 and group 2, respectively. Cross-over to the highest energy level was never effective. TOC tolerability was optimal (mean discomfort score 1.2 on a 1-4 grading scale). Markers of myocardial necrosis did not increase and no procedure-related complications occurred. On logistic regression analysis, the most predictive variables of unsuccessful cardioversion were AF duration (P = 0.0001) and low left atrial appendage emptying velocity (P = 0.02). Both TOC and TTC with biphasic shocks are effective and safe for SR restoration in patients with persistent AF; however, the considerably lower levels of delivered and effective energies for SR restoration allow TOC to be performed during mild sedation with optimal tolerability, thus avoiding general anaesthesia.

Correlation between putative indicators of primary restless legs syndrome severity

Background and purpose Several methods of assessing disease severity in restless legs syndrome (RLS) have been suggested. The purpose of this study was to examine the relationship between the suggested immobilization test (SIT), the International RLS Study Group rating scale (IRLS), sleep efficiency, and periodic leg movements of sleep index (PLMI). Patients and methods Forty primary RLS patients with periodic leg movements of sleep were included in this prospective study. Study procedures were all performed during the same night, beginning with IRLS administration and following with SIT and polysomnography (PSG) evaluations, in that order. SIT was composed of two parameters: SIT mean discomfort score (SIT-MDS) and SIT periodic leg movements of wakefulness index (SIT-PLMW). PSG target measures were PLMI and sleep efficiency. Pearson's correlation was used for analysis at a P < 0.01 significance level. Results PSG-PLMI correlated with IRLS ( r = 0.462; P = 0.003) and with SIT-PLMW ( r = 0.681; P = 0.0004). A correlation was also found between IRLS and SIT-MDS ( r = 0.447; P = 0.004), even though SIT-PLMW and IRLS did not correlate with each other ( P = 0.286). A negative correlation was found between PSG-PLMI and sleep efficiency ( r = −0.435; P = 0.005). Neither SIT nor IRLS correlated with sleep efficiency. Only SIT discomfort scores from the second half of SIT correlated with SIT-PLMW ( r = 0.457, P = 0.004), and they had a stronger correlation with IRLS ( P = 0.003). Conclusions This study attempted a much needed comprehensive evaluation of the relationship between various RLS severity indicators. Our findings support a strong role of motor dysfunction on sleep quality in RLS, as well as the potential use of SIT-PLMW as a sensitive indicator of RLS severity.

Patient-Controlled Room Air Insufflation Versus Automated Carbon Dioxide Delivery for CT Colonography

Our objective was to prospectively compare colonic distention and patient comfort at screening CT colonography (CTC) with patient-controlled room air (RA) insufflation versus automated carbon dioxide (CO2) delivery. Two hundred eight adults undergoing CTC were randomized to RA or CO2 (104 per method). Colonic distention was prospectively assessed by segment using a 4-point scale (1 = optimal, 2 = adequate, 3 = inadequate, 4 = collapsed). Adequacy of combined supine/prone segmental evaluation was also recorded. Patients provided discomfort ratings on a 0-10 scale (0-1 = none/insignificant, 2-3 = minimal, 4-6 = intermediate, 7-10 = significant) before, during, and after the procedure. No significant differences in segmental distention were observed in the prone position between techniques. In the supine position, CO2 resulted in significantly greater distention in the sigmoid, descending, and transverse segments (p < 0.01). After combined supine/prone assessment, two/104 (1.9%) and three/104 (2.9%) patients were judged to have an inadequately evaluated segment on RA and CO2, respectively (four sigmoid, one transverse). Mean discomfort scores for RA and CO2 were 3.97 and 5.08 during the examination (p < 0.01); 0.91 and 0.42 immediately after (p < 0.01); 0.51 and 0.25 15 min later (p < 0.05); and 0.15 and 0.04 2 hours later (p < 0.01), respectively. During active distention, 19 (18.3%) and 33 (31.7%) patients reported significant transient discomfort with RA and CO2, respectively (p < 0.05). Beyond 15 min, only two (1.9%) patients with RA and no patients with CO2 had a discomfort level higher than 3. Although patient-controlled RA insufflation and automated CO2 delivery each resulted in negligible postprocedure discomfort and reliable colonic distention, CO2 was better for both categories.

The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine

This prospective, randomized, double-blind, controlled study was designed to test the effect of pre-anaesthetic administration of dexmedetomidine, given as a single intravenous (i.v.) dose, on postoperative pain scores and morphine consumption in patients receiving patient-controlled morphine after abdominal surgery. Sixty patients were randomly allocated to receive dexmedetomidine (1 microg kg(-1)) or saline 10 min before induction of anaesthesia. Twenty minutes before the end of surgery, all patients received a standardized (0.1 mg kg(-1)) loading dose of morphine. They were then allowed to use a patient-controlled analgesia (PCA) device giving bolus doses of morphine (0.02 mg kg(-1)). Pain, discomfort and sedation scores; cumulative morphine consumption; time to extubation; time to recovery; and any side-effects were recorded after recovery and at 1, 2, 6, 12 and 24 h after the start of PCA. The mean time to extubation at the end of anaesthesia and recovery time were similar in both groups. There were no significant differences between groups with regard to mean pain, discomfort, sedation and nausea scores. Cumulative morphine consumption was significantly lower in the dexmedetomidine group at 6, 12 and 24 h (P < 0.05). The incidence of side-effects did not differ between the groups. A single i.v. dose of dexmedetomidine (1 microg kg(-1)) given 10 min before induction of anaesthesia significantly reduced postoperative morphine consumption at identical pain scores compared to control, but had no effect on postoperative recovery time.

2% Sodium Fluoride‐Iontophoresis Compared to a Commercially Available Desensitizing Agent

Dentin hypersensitivity is a common clinical condition and age-old complaint, presenting problems to both the patient and the dentist. Besides causing discomfort, the condition may deter a person from establishing or maintaining adequate oral hygiene procedures, further complicating oral health. The failure to practice satisfactory plaque control has well-established consequences on gingival and periodontal health. Thus, a cycle of sensitive teeth leading to reduced plaque control, more periodontal disease, and more recession may be established. The hypersensitive teeth were identified by the patient and verified by the light stroke of a dental explorer along the cervical area of all teeth present. Subjects fulfilling the inclusion and exclusion criteria were evaluated using tactile, 1-second air blast, and cold water stimuli, and the subject's response was recorded on the verbal rating scale. A total of 425 teeth from 50 patients included in this study were randomly divided into two groups: group 1, who received 2% sodium fluoride-iontophoresis (NaF) and group 2, who received an aqueous solution of hydroxy-ethyl-methacrylate and glutaraldehyde (HEMA-G). The teeth were evaluated immediately after treatment and at 2 weeks, 1 month, and 3 months. In case of failure at the 2-week interval, the affected tooth was retreated with the same drug as before and evaluated further. The results were statistically analyzed, and it was found that group 1 treatment was more effective than group 2 at 1- and 3-month intervals. There was a comparatively greater recurrence of hypersensitivity in group 2. A comparable number of teeth required repeat dosage in both groups. Teeth which required repeat dosage had greater mean discomfort scores at baseline for all three tests than the teeth which did not require a repeat dose. Both agents showed significant reduction in sensitivity at all time intervals compared to baseline; however, NaF had a comparatively greater effect than HEMA-G at both the 1- and 3-month intervals; an almost equal number of teeth in both groups required repeat doses. Teeth with a higher initial sensitivity score required a repeat dose. Both agents were found to be equally effective immediately after application; the 2% NaF was comparatively better than HEMA-G in providing long-term relief.

Relationship between Complications due to Prostate Biopsy and the Scores of Pain and Discomfort

Introduction: Transrectal ultrasound (TRUS)-guided prostate biopsy is routinely performed in the prostate-specific antigen era. In this study, we evaluated morbidity and complications observed in patients undergoing TRUS-guided prostate biopsy following intrarectal lidocaine application and the relation of these complications to pain and discomfort. Patients and Methods: Between January 2000 and August 2002, a total of 128 patients underwent TRUS-guided prostate biopsy. The procedure was carried out following an intrarectal application of 10 cm³ 2% lidocaine gel. Immediately after the biopsy, pain and discomfort scores were determined using a 10-point linear visual analog scale. The patients were seen 10 days later and questioned for complications. Results: At least one complication was observed in 107 patients (84%). Most frequent complications were macroscopic hematuria (90%), hematochezia (36%), and hematospermia (13%). The mean pain and discomfort scores of the patients were found to be correlated to each other (p < 0.01). The complication-negative group had significantly lower pain and discomfort scores (p < 0.01). The scores of the patients with hematochezia were significantly higher than the scores of the patients with other complications (p < 0.01). Conclusions: Minor complications like hematuria, hematochezia, and hematospermia are frequently seen in patients undergoing TRUS-guided prostate biopsies. The pain and discomfort scores may be predictors of minor complications, particularly of rectal bleeding.

Pre-emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery

Studies of pre-emptive analgesia in humans have shown conflicting results. This prospective, randomized, double-blind, controlled study was designed to test the hypothesis that a reduction in postoperative morphine consumption can be achieved by tramadol administered after induction of anaesthesia. Ninety patients were allocated randomly to receive i.v. tramadol (1 mg kg(-1)) (Group T), morphine (0.1 mg kg(-1)) (Group M) or saline 2 ml (Group S) after induction of anaesthesia. At peritoneal closure, a standardized (0.1 mg kg(-1)) morphine loading dose was given to all patients for postoperative pain management. Patients were allowed to use a patient-controlled analgesia (PCA) device giving bolus doses of morphine 0.025 mg kg(-1). Discomfort, sedation, pain scores, cumulative morphine consumption, and side-effects were recorded at 1, 2, 6, 12 and 24 h after the start of PCA. There were no significant differences between groups in mean pain, discomfort, and sedation scores at any study period. Cumulative morphine consumption was significantly lower in Group M at 12 and 24 h after starting the PCA than in Group S. In Group T, it was lower only after 24 h (28% less in Group M and 17% less in Group T; P<0.017). There were no significant differences in morphine consumption between Groups T and M. Tramadol (1 mg kg(-1)), administered after induction of anaesthesia, offered equivalent postoperative pain relief, and similar recovery times and postoperative PCA morphine consumption compared with giving morphine 0.1 mg kg(-1). These results also suggest that presurgical exposure to systemic opioid analgesia may not result in clinically significant benefits .

Comparison of lidocaine 2% gel versus amethocaine as the sole anesthetic agent for strabismus surgery

Purpose To compare the efficacy of lidocaine 2% gel with amethocaine 1% eyedrops as the sole anesthetic agent for one-stage adjustable suture strabismus surgery. Design Prospective, double-masked randomized trial. Participants Fourteen consecutive patients scheduled to undergo bilateral and symmetrical strabismus surgery under topical anesthesia in one institution. Methods Each patient was randomized to receive lidocaine 2% gel in one eye and amethocaine 1% eyedrops in the other eye as the sole anesthetic agent for surgery. Masking of the patient and surgeon was ensured by administration of a placebo gel and eyedrop as part of the regimen. Pain and discomfort were assessed via a 10-cm visual analog scale. Main outcome measures Subjective pain and discomfort perceived during surgery were assessed separately by the patient and the surgeon, and the need for any additional anesthesia was recorded. Results A total of 14 subjects indicated mean pain and discomfort scores of 2.6 and 3.2 respectively, for lidocaine gel, and 5.3 and 6.2, respectively, for amethocaine drops ( P = 0.01). The mean number of additional drops required by eyes randomized to lidocaine gel was 0.3, compared with 1.6 for amethocaine drops ( P = 0.02). Conclusions In terms of pain control, lidocaine 2% gel alone is a superior topical anesthetic for one-stage adjustable suture strabismus surgery when compared with amethocaine 1% eyedrops.