Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 1997
Alleviation of the peripheral hemodynamic effects of dexmedetomidine by the calcium channel blocker isradipine.
Alpha 2-adrenergic agonists have peripheral vasoconstrictive effects and central sympatholytic and sedative effects. Whereas the latter are the basis of their use in anesthesia, the former could limit their clinical application. ⋯ Isradipine could alleviate the peripheral hemodynamic actions of dexmedetomidine while having no effect on its central sympatholytic properties.
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Acta Anaesthesiol Scand · Mar 1997
Randomized Controlled Trial Clinical TrialAnesthetic quality during cesarean section following subarachnoid or epidural administration of bupivacaine with or without fentanyl.
It is often assumed that subarachnoid administration of local anesthetics produces a more profound blockade than epidural anesthesia. Furthermore, the addition of fentanyl has been reported to increase preferentially intraoperative analgesia. In the present study we set out to study these two issues in a randomized and controlled study with respect to perceived pain and discomfort during surgery and postoperative pain. ⋯ We conclude that subarachnoidal (12.5 mg) and epidural (100 mg) injections with bupivacaine both produced adequate anesthetic quality in women undergoing elective cesarean section. The addition of fentanyl (10 micrograms subarachnoidally or 100 micrograms epidurally) did not significantly improve the quality of these already profound blockades.
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Acta Anaesthesiol Scand · Mar 1997
Assessment of postoperative pain: impact of clinical experience and professional role.
Unrelieved postoperative pain is still reported to be a rather common clinical problem which may be related to inadequate routines for pain assessment. Therefore, the aim of the study was to describe strategies used by experienced and less experienced nurses and physicians in their assessment of postoperative pain and to relate different approaches, clinical experience, and professional role to the accuracy of the pain ratings. ⋯ The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients.
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Acta Anaesthesiol Scand · Mar 1997
Case ReportsFour years' treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia.
N-methyl-D-aspartate (NMDA) receptors are involved in the development of neuropathic pain. Ketamine, a non-competitive NMDA receptor antagonist, has in several case reports given pain relief but efficacy in dosages tolerated in long-term ketamine treatment is unknown. Another substance with an antagonist action at NMDA receptors and which is approved for peroral administration is dextromethorphan. ⋯ We report a patient with severe post-herpetic pain resistant to conventional pain treatment which was treated with ketamine for 4 years with good pain relief. The practical application of long-term treatment in different administration forms of ketamine is described. The patient also responded with pain relief in a double-blind trial with oral dextromethorphan.
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Acta Anaesthesiol Scand · Mar 1997
Randomized Controlled Trial Clinical TrialIntravenous regional analgesia using morphine. The effect on postoperative pain following total knee arthroplasty.
We hypothesised that any peripheral action of morphine may contribute to improved postoperative analgesia. The aim of this study was to evaluate the analgesic efficacy of morphine administered preoperatively into an exsanguinated limb prior to total knee arthroplasty. ⋯ Intravenous regional analgesia using morphine provides no analgesic advantage over the intramuscular route from 6-24 h postoperatively.