Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Comparative Study Clinical TrialA randomized double-blind comparison of epidural fentanyl infusion versus patient-controlled analgesia with morphine for postthoracotomy pain.
The authors conducted a prospective, randomized, double-blind comparison of an epidural fentanyl infusion versus patient-controlled analgesia (PCA) with morphine in the management of postthoracotomy pain. Thirty-six patients were randomized into one of two groups. The epidural group received an epidural fentanyl infusion, 10 micrograms/mL, and saline through their PCA machine. ⋯ There were no differences in postoperative forced vital capacity between the two groups. More patients in the PCA group had greater degrees of sedation on postoperative day 1 (P = 0.005), whereas pruritus was more frequent (P < 0.02) in the epidural group. We conclude that an epidural fentanyl infusion is superior to that of PCA with morphine in the management of pain after thoracotomy.
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialEffects of epidural morphine and intramuscular diclofenac combination in postcesarean analgesia: a dose-range study.
To assess the efficacy of combinations of epidural morphine and intramuscular diclofenac in postcesarean analgesia, a double-blind, randomized study was conducted. Epidural anesthesia was administered to 120 parturients who were randomly allocated into six treatment groups; these groups, A, B, C, D, and E, received 0.5, 1, 2, 3, and 4 mg of epidural morphine in 10 mL of normal saline solution, respectively, and 75 mg (3 mL) of diclofenac intramuscularly (IM). Group F received 4 mg of epidural morphine in 10 mL of normal saline solution and 3 mL of normal saline solution IM. ⋯ The incidence of nausea or vomiting or both, pruritus, and bleeding was similar. There was no evident relationship between severity of pruritus and morphine doses. No bradyspnea was observed during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialOral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain.
Oral transmucosal fentanyl citrate (OTFC) has been used in a variety of clinical situations. This study was designed to determine if OTFC could provide analgesia to patients with acute pain after major surgery. Following written informed consent, 38 ASA Physical Status I-III patients undergoing either a total hip replacement or total knee arthroplasty were studied prospectively. ⋯ Twenty-eight patients completed the study, 13 in the control group and 15 in the OTFC group. There were no significant differences between the study groups as to patients' age, gender, ASA classification, or surgical procedure. In addition, there were no differences between the groups in the number of PCA attempts or delivered dose of morphine during the prestudy or poststudy periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1993
"Do not resuscitate" (DNR) orders and the anesthesiologist: a survey.
Anesthesiologists were surveyed to determine their experience and opinions regarding "Do Not Resuscitate" (DNR) orders in the perioperative period. Four hundred fifteen questionnaires were mailed and 193 (47%) were returned. One hundred sixty-one (87%) of 186 respondents had been requested to provide (and more than two-thirds had provided) monitored anesthesia care, regional anesthesia, or general anesthesia to a patient with a DNR order. ⋯ After agreeing to a patient's decision to retain their DNR status, > 67%, > 58%, < 49%, and < 33% would utilize positive pressure ventilation with a mask, vasoactive drugs, endotracheal intubation, or defibrillation, respectively, in the event of a cardiopulmonary arrest in the perioperative period. These findings suggest much ambiguity regarding DNR orders in the perioperative period. Further discussion among physicians and patients is warranted.
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Anesthesia and analgesia · Feb 1993
Comparative StudyA comparison of postoperative epidural analgesia between patients with chronic cancer taking high doses of oral opioids versus opioid-naive patients.
Our study evaluated 116 surgical patients with cancer who received postoperative epidural analgesia with bupivacaine (BUP) (0.1%) and morphine (MS) (0.01%) during 5 days after epidural-light general anesthesia. Patients in group I (n = 17) were taking opioids in doses larger than 50 mg of morphine daily for 3 mo or more, whereas patients in group II (n = 99) were opioid-naive. Postoperative epidural infusions were started at 10 mL.h-1 for group I and 5 mL.h-1 for group II. ⋯ Daily epidural and IV MS usage were always more for group I by two- to threefold. No patient experienced respiratory depression or opioid withdrawal during the hospitalization. Thus, epidural BUP-MS appears to provide adequate postoperative analgesia while preventing withdrawal in opioid-dependent patients, if three times the normal dosage and duration of therapy are employed.