European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Intrathecal morphine in cardiac surgery.
The effects of intrathecal morphine in 60 patients undergoing open-heart surgery were studied in an observer-blind control trial. The patients were randomly allocated into three groups of 20 each: (A) Control, (B) 2 mg and (C) 4 mg of intrathecal morphine. This study confirms that intrathecal morphine provides useful post-operative analgesia. ⋯ Since the completion of this study, reports have suggested that 1 mg of morphine intrathecally avoids the serious complications of respiratory depression. In the study described, the patients were electively ventilated post-operatively and respiratory depression was therefore not a problem. Of the other associated side-effects of intrathecal morphine, vomiting (20%) and pruritus (20%) proved the most troublesome.
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Review
Systemic and specific autonomic reactions in pain: efferent, afferent and endocrine components.
The sympathetic nervous system is hierarchically organized. At the bottom of this organization are the sympathetic pre-post-ganglionic channels which supply the autonomic target organs, at the top the hypothalamus and cortical structures. Each level of this hierarchy contains neuronal programmes which govern the sympathetic activity in a patterned fashion. ⋯ No conclusive experimental evidence exists to show that peripheral nociceptors are controlled by activity in sympathetic post-ganglionic neurones. In certain pathophysiological situations, however, it may happen that activity in sympathetic post-ganglionic neurones, which supply an extremity, leads to excitation of afferent axons, thus establishing a vicious circle between primary afferent neurones, spinal cord and sympathetic outflow. This situation may occur after partial lesions of peripheral nerves in a syndrome which is called 'reflex sympathetic dystrophy'.