Anesthesiology
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Randomized Controlled Trial Clinical Trial
Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery.
Addition of fentanyl to bupivacaine administered for spinal anesthesia for cesarean delivery was evaluated in 56 ASA physical status 1 term parturients. Preservative-free saline was added to 0, 2.5, 5, 6.25, 12.5, 25, 37.5, or 50 micrograms fentanyl to make a 1 ml total volume, which was injected intrathecally prior to bupivacaine in a double-blind, randomized fashion. Vital signs, sensory level, motor block, pain score, and side effects were recorded every 2 min for the first 12 min and then at 15, 30, 45, and 60 min and at 30-min intervals until the patient complained of pain. ⋯ None of the patients who received greater than or equal to 6.25 micrograms fentanyl required intraoperative opioids. Complete analgesia (time from injection to first report of pain) lasted 33.7 +/- 30.8 min (mean +/- SD) in the control group and increased to 130 +/- 30 min (P less than 0.05) with addition of 6.25 micrograms fentanyl. Duration of effective analgesia (time from injection to first parenteral opioid) was 71.8 +/- 43.2 min in the control group and increased (P less than 0.05) to 192 +/- 74.9 min with addition of 6.25 micrograms fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
An evaluation of morphine and oxymorphone administered via patient-controlled analgesia (PCA) or PCA plus basal infusion in postcesarean-delivery patients.
The analgesic efficacy and adverse effects of morphine and oxymorphone in 32 patients who received traditional patient-controlled analgesia (PCA) following cesarean delivery were compared with those in 32 other patients receiving the same agents via PCA plus basal opioid infusion (PCA + BI). All patients were operated upon during epidural anesthesia with 2% lidocaine and 1:200,000 epinephrine to achieve a T4 sensory level. Upon first complaint of pain in the recovery room, patients were given a titrated iv loading dose of the assigned opioid until comfortable and were then provided with a programmable PCA device. ⋯ The level of sedation and incidence of nausea/vomiting and pruritus were also recorded. Patients utilizing PCA + BI noted significant reductions in resting pain scores with oxymorphone and decreased pain during movement with both opioids when compared with individuals using PCA alone (P less than 0.05). There were no significant differences between treatment groups in 24-h dose requirements or patient satisfaction with therapy (P = ns).(ABSTRACT TRUNCATED AT 250 WORDS)