Articles: analgesics.
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Regional anesthesia · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialMaternal analgesia and neonatal effects of epidural sufentanil for cesarean section.
This study was designed to evaluate the maternal intraoperative and postoperative analgesia and neonatal effects of adding sufentanil to epidural anesthesia for cesarean section before the skin incision. Forty-five multipara were randomized in three equal groups to receive sufentanil 80 micrograms, 50 micrograms, or saline with the epidural lidocaine. Intraoperative and postoperative analgesia and side effects were recorded. ⋯ Postoperative analgesia was prolonged after sufentanil, but side effects increased with the greater dose. The infants whose mothers received 80 micrograms sufentanil showed a mild neurobehavioral depression. It is therefore concluded that the addition of 50 micrograms of sufentanil improves both intraoperative and postoperative analgesia without significant neonatal effects.
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Comparative Study
Neuromuscular and cardiovascular effects of mivacurium chloride in surgical patients receiving nitrous oxide-narcotic or nitrous oxide-isoflurane anaesthesia.
The neuromuscular and cardiovascular effects of mivacurium chloride were studied during nitrous oxide-oxygen narcotic (fentanyl) (n = 90) and nitrous oxide-oxygen isoflurane (ISO) anaesthesia (n = 45). In addition, a separate group (n = 9) received succinylcholine during fentanyl anaesthesia to compare its neuromuscular effects with mivacurium. Mivacurium was initially administered as a single bolus in doses from 0.03 mg.kg-1 to 0.25 mg.kg-1 to study the dose-response relationships, as well as the cardiovascular effects of mivacurium. ⋯ There was minimal change in mean arterial pressure (MAP) or heart rate (HR) following bolus doses of mivacurium up to 0.15 mg.kg-1. Bolus administration of 0.20 mg.kg-1 or 0.25 mg.kg-1 of mivacurium decreased MAP from 78.2 +/- 2.5 to 64.0 +/- 3.2 mmHg (range 12-59 per cent of control) (P less than 0.05). The same doses when administered slowly over 30 sec produced minimal change in MAP or HR.
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Fifteen patients with cancer pain refractory to other methods of pain control were treated with epidural sufentanil. They all suffered from very severe or unbearable pain but had expressed the wish to spend the last period of their lives at home. On the first day of hospitalization, an epidural catheter and a portal catheter were implanted under local anesthesia. ⋯ Nine patients had epidural sufentanil as their sole analgesic till they died; six patients needed adjunctive nonepidural medications. There were no epidural- or portal-catheter related infections or cases of respiratory depression. After 1651 patient treatment days, we have found continuous epidural sufentanil infusion to be a safe and effective method for cancer pain control in outpatients.
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The treatment of pain in patients with terminal cancer of the head and neck is discussed. The treatment must be tailored to the individual patient and should use oral agents if possible. ⋯ Neuroleptics are important adjuvant analgesics, which have proved to be particularly valuable for more severe pain in head and neck cancer. This treatment can be carried out either in hospital or in domiciliary practice.
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Arch Int Pharmacodyn Ther · Nov 1989
Lack of importance of caffeine as an analgesic adjuvant of dipyrone in mice.
The analgesic effect of caffeine used alone and in combination with dipyrone and butalbital was evaluated after oral administration in mice, using two different pain tests: the hot plate test and the phenylbenzoquinone-induced writhing test. Neither caffeine (5 to 200 mg/kg) nor butalbital (10 and 20 mg/kg) (20 mg/kg was the highest dose that did not induce sleep) produced a significant antinociceptive effect, whereas dipyrone was active from 400 mg/kg in the hot plate test and from 50 mg/kg in the writhing test. The scores obtained with the combinations were not different from those of the dipyrone-treated group, except for the butalbital-dipyrone combination. Thus caffeine is not an analgesic adjuvant in mice; its presence in the combination studied appears to be justifiable only insofar as it inhibited the sedative effect of butalbital.