Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Mar 1982
Clinical Trial Controlled Clinical TrialEpidurally administered morphine for postcesarean analgesia.
A double blind study was performed to evaluate analgesia from epidurally injected morphine sulfate in 30 mothers after cesarean section following similar regional anesthetics. When compared with a saline placebo and 2 milligrams of epidurally injected morphine, a 4.5 milligram epidurally administered morphine dose resulted in a highly significant reduction in the initial 24 hour parenterally administered narcotic requirement, p less than 0.001, and a significantly greater duration of analgesia after epidural injection, p less than 0.0003. ⋯ No significant side-effects were noted. Epidurally administered morphine appears promising as a potent analgesic approach of extended duration with potential advantages for early maternal mobilization, improved fetal maternal interaction and reduced fetal narcotic exposure in the breast fed infant.
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Spontaneous pneumoperitoneum may pose a diagnostic dilemma, especially when evaluating a patient who has no or minimal abdominal or constitutional findings accompanying its presence. The free intraperitoneal air may be the result of a perforation of a hollow viscus in such instances. Under these circumstances, the air is most often from another source. ⋯ Diagnostic and therapeutic procedures in or adjacent to the abdomen may result in an iatrogenic pneumoperitoneum. In each instance when the findings of an acute abdominal catastrophe are lacking, the circumstances present before the discovery of the pneumoperitoneum should give a clue to the appropriate diagnosis. When a reasonable nonsurgical cause can be discerned, continued observation may be sufficient, thus avoiding an unnecessary laparotomy.