Patient-controlled Sedation Clinical Trial
Official title:
Propofol Sedation in Orthopaedic Surgery Under Central Neuraxial Block: Patient-controlled Sedation Versus Target-controlled Infusion
Orthopaedic surgeries involving the legs can be done under nerve block, where patients will be numb of pain at the operated site but awake during surgery. Sedation can be given to allay anxiety and provide comfort throughout the surgery. Sedation can be given by the anaesthetic doctors by using target-comtrolled infusion pump, or self-administered by patients by means of specialised machines. This study compares two method of administration of sedation, patient-controlled sedation (PCS) versus target-controlled infusion sedation (TCIS) by anaesthetic doctors, in people undergoing orthopaedic surgeries under nerve block.
Central neuraxial block (CNB) is one of the mainstays of anaesthesia methods in various
disciplines particularly orthopaedic surgeries. However the state of consciousness can
potentially cause patient anxiety thus sedation is often utilized as a mean to improve
patient satisfaction and increase patient acceptance of CNB.
Conventionally, the anaesthesiologist administers sedatives for the patients. Propofol is the
commonly used drug for sedation due to its favourable pharmacokinetic profile, which results
in fast induction, easy control of depth of sedation and rapid recovery. It can be infused by
using target-controlled infusion (TCI) devices where the anaesthetists titrates propofol by
setting desired target plasma and effect site concentration. However it is difficult to judge
precisely patient requirements for adequate patient sedation, comfort and analgesia as
patients' needs differ.
Patient-controlled sedation (PCS) is a valid option, initially adapted from post surgery
patient-controlled analgesia. It allows patients to titrate sedative medication to their
comfort and therefore present an option that addresses the needs of patients with strong
desire to maintain sense of control during procedures.
This study was designed to compare total propofol requirement between PCS versus TCI sedation
(TCIS), complications and patient satisfaction, in patients undergoing lower limb orthopaedic
surgery under CNB.
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