Anesthesia and analgesia
-
Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Clinical TrialSmall dose bupivacaine-fentanyl spinal analgesia combined with morphine for labor.
We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 micro g of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 micro g of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The median duration of analgesia was similar between groups (89 min versus 84 min; P = not significant), and only 20% of the MBF group experienced prolonged analgesia. During subsequent epidural analgesia, the MBF group had a significantly lesser rate of breakthrough pain (0.15 +/- 0.14 episodes per hour versus 0.26 +/- 0.18 episodes per hour; P = 0.02). Also, during the first 24 h postpartum, the MBF group required significantly fewer medications (3.3 +/- 3.7 doses versus 4.7 +/- 3.5 doses; P = 0.04). Intrathecal injection of this small dose of bupivacaine/fentanyl produced a rapid onset of labor analgesia; the addition of a small dose of morphine did not significantly prolong analgesia, but it improved subsequent pain relief, as measured by the rate of breakthrough pain and postpartum medication requirements. This may provide a clinically useful means of improving intra- and postpartum pain relief. ⋯ A small dose of intrathecal fentanyl 12.5 micro g and bupivacaine 2 mg produces effective labor analgesia lasting for approximately 85 min. The addition of a small 125- micro g dose of morphine improves pain control during subsequent epidural analgesia and reduces the requirements for postpartum pain medications.
-
Anesthesia and analgesia · Jul 2003
Clinical TrialChronic treatment with antidepressants decreases intraoperative core hypothermia.
We investigated temperature regulation during anesthesia and postoperative shivering in chronically depressed patients given antidepressant drugs. We studied 35 depressed patients and 35 control patients who underwent orthopedic surgery. Tympanic membrane temperatures 60, 75, and 90 min after induction in the depression group were significantly (P < 0.05) higher than those of the control group. There were no significant differences in mean skin temperature between the depression and the control groups. Eight of 35 patients in the depression group and 2 of 35 patients in the control group developed postanesthetic shivering. The incidence of shivering in the depression group was significantly more frequent than that in the control group (P = 0.04). The tympanic membrane temperature of the patients treated with clomipramine tended to be higher than that of the patients treated with maprotiline. In conclusion, intraoperative core hypothermia in chronically depressed patients was decreased. However, the incidence of shivering in depressed patients was significantly more frequent. ⋯ Thermoregulation in chronically depressed patients is often altered. The alteration of body temperature is affected by depression itself and by antidepressants. General anesthesia has an influence on thermoregulatory control. However, temperature regulation during anesthesia in chronically depressed patients remains unclear.
-
Anesthesia and analgesia · Jul 2003
Case ReportsAllodynia after acute intrathecal morphine administration in a patient with neuropathic pain after spinal cord injury.
Acute intrathecal administration of relatively small doses of opioids may precipitate neuropathic pain and allodynia in those with spinal cord injury.