Articles: analgesia.
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Int J Technol Assess Health Care · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialAn economic evaluation of pain therapy after hysterectomy. Patient-controlled analgesia versus regular intramuscular opioid therapy.
To assess the economics of patient-controlled analgesia (PCA) treatment versus regular intramuscular (i.m.) injections of opioid analgesia for pain management after hysterectomy. ⋯ Based upon the institutions and assumptions in this analysis, PCA offers no cost advantages over regular i.m. therapy in the pain management after hysterectomy. Regular i.m. injections provided less costly analgesia.
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Int J Obstet Anesth · Jan 1999
An audit of single dose epidural diamorphine during elective caesarean section at a district general hospital.
Mothers receiving combined spinal-epidural (CSE) anaesthesia for elective caesarean section (n = 188) were audited. A single dose of epidural diamorphine (2-3 mg) was given during surgery. Unless contraindicated, diclofenac 100 mg was given per rectum at the end of surgery. ⋯ Nausea was uncommon: mild (19%), moderate (10%), severe (2%); 16% of mothers received anti-emetics. Itching was less than previous reports with subarachnoid diamorphine. Single dose epidural diamorphine can be used during elective caesarean section rendering systemic opiates unnecessary.
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Epidural and intrathecal techniques are well established techniques in cancer pain. However, several questions remain unresolved. The several problems of long-term spinal opioid treatment in advance cancer patients were reviewed. ⋯ Different ranges of technical complication rates have been reported in the literature, most of them being associated with epidural catheters. Subcutaneous tunneling and fixation of the catheter, bacterial filters, minimum changes of tubings, careful exit site care weekly, site protection and monitoring of any sign of infection to prevent infection, and training for family under supervision, are recommended. Areas for additional research include the use of spinal adjuvants, the ideal spinal morphine-bupivacaine ratio. methods to improve spinal opioid responsiveness and long-term catheter management with appropriate home care programs.
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Randomized Controlled Trial Clinical Trial
[Epidural analgesia in total gastrectomy--combination of bupivacaine with ketamine or fentanyl].
The effects of intraoperative epidural administration of ketamine added to bupivacaine were compared with fentanyl added to bupivacaine in patients undergoing total gastrectomy. Prospective, randomized, double blind study was designed to compare: group F: 20 patients (pts) receiving 20 ml of 0.125% bupivacaine and 50 ug of fentanyl and group K: 20 pts in whom 20 ml of 0.125% bupivacaine was combined with 50 mg of ketamine. Pts received an epidural injection through peridural catheter introduced through either T7-8 or T8-9 interspinous space. ⋯ None of the pts complained of bad dreams or awakeness during operation. Both fentanyl and ketamine added to bupivacaine and given as a bolus provided good intraoperative analgesia in combination with general anaesthesia, minimal sensorimotor disturbance and early tracheal extubation. In our study fentanyl added to bupivacaine caused higher incidence of hypotension than ketamine added to bupivacaine.