Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA.
We have compared the efficacy of patient-controlled interscalene analgesia (PCIA) using ropivacaine with patient-controlled analgesia (PCA) using nicomorphine in 60 patients (n = 30 in each group), in a prospective, randomized study. In both groups, all patients received interscalene block with 0.75% ropivacaine before induction of anaesthesia. Six hours after interscalene block, patients in group PCIA received continuous infusion of 0.2% ropivacaine at a rate of 5 ml h-1 with a bolus dose of 3 or 4 ml and a lockout time of 20 min; patients in group PCA received continuous infusion of nicomorphine 0.5 mg h-1 and a bolus dose of 2 or 3 mg with a lockout time of 20 min. ⋯ Nausea and pruritus occurred significantly more frequently in group PCA. Patient satisfaction was greater in group PCIA. We conclude that the use of 0.2% ropivacaine using PCIA was an efficient way of managing pain after major shoulder surgery and compared favourably with PCA nicomorphine in terms of pain relief, side effects and patient satisfaction.
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Randomized Controlled Trial Clinical Trial
Regional analgesia in early active labour: combined spinal epidural vs. epidural.
We randomly allocated 93 women in early active labour and requesting epidural analgesia to receive either epidural (n = 48) or combined spinal-epidural analgesia (n = 45). For epidural analgesia 15 ml of bupivacaine 0.1% with 75 micrograms of fentanyl were injected into the epidural space. For combined spinal-epidural analgesia 1 ml of bupivacaine 0.25% with 25 micrograms of fentanyl were injected into the subarachnoid space. ⋯ The PCEA machine failed completely twice and temporarily many times. We conclude that the combined spinal-epidural technique confers no advantages in early active labour. Also, a lightweight PCEA pump needs to be more reliable before we can recommend its use.
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Int J Obstet Anesth · Oct 1998
Incidence of epidural catheter replacement in parturients: a retrospective chart review.
We noted in our practice of obstetric anesthesia at a large teaching hospital that the epidural catheter failure rate was higher than previously reported. We undertook this study to determine the incidence of epidural catheter failure in parturients and to determine the primary causes of failure. After institutional approval, we evaluated the charts of parturients who received epidural analgesia for labor or anesthesia for cesarean section for 6 randomly selected months spanning one year. ⋯ The major causes of catheter failure were no analgesia and unilateral block. The experience of the anesthesiologist, the mode of delivery, patient age, patient weight, type of epidural catheter, occurrence of paresthesia and the use of CSE were all associated with significantly different epidural catheter replacement rates. Despite the initially high failure rate, the overall patient satisfaction rate was greater than 98%.
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Randomized Controlled Trial Clinical Trial
Postoperative intrathecal patient-controlled analgesia with bupivacaine, sufentanil or a mixture of both.
In a randomised double-blind study, 45 patients, scheduled for major orthopaedic surgery under continuous spinal anaesthesia, received for relief of postoperative pain patient-controlled analgesia with either sufentanil 2 micrograms.ml-1, bupivacaine 0.0625% or a mixture of both by the intrathecal route. The mean (SD) consumption of sufentanil and bupivacaine during the first 12 h was 65.5 (27.1) micrograms and 18.2 (4.8) mg, respectively. Combining bupivacaine and sufentanil reduced the consumption of both to approximately 40% as compared to the administration of each component separately. ⋯ Tachyphylaxis did not occur. It was concluded that the groups receiving plain bupivacaine and sufentanil alone experienced pain relief of good quality. The use of a mixture, however, accelerated the onset of analgesia, improved the analgesic quality and reduced the doses for both components by 60% but at the expense of a higher incidence of nausea and vomiting.
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Anaesth Intensive Care · Oct 1998
Obstetricians' knowledge and attitudes toward epidural analgesia in labour.
A survey of all registered obstetrician/gynaecologists in Western Australia (n = 79) was conducted to obtain information regarding their level of knowledge about epidural analgesia (EA) in labour and its complications, their sources of information about EA, and their opinions regarding its role in labour and effect on progress of labour. Response rate was 68%. Most respondents had only received lectures about EA after specialist training and 20% did not achieve an adequate knowledge score. ⋯ Seventy-seven per cent believed EA prolonged the second stage of labour, though opinion varied regarding EA effects on the duration and progress of first and third stages. Up to thirty minutes delay before epidural placement is acceptable to 87%. This survey suggests that there is both a demand and a need for greater education about EA in labour, particularly with respect to EA side-effects, complications and effects on labour, in the subgroup of obstetricians who have been in obstetric practice more than five years.