Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour.
We have compared analgesia during labour provided by two epidural drug regimens, in a double-blind, randomized, controlled study. Group A received 10-ml bolus doses of 0.1% bupivacaine with fentanyl 2 micrograms ml-1 while group B received 0.25% plain bupivacaine 10 ml. ⋯ Duration of labour and time from insertion of the epidural to delivery was similar in both groups, but in group A, duration of the second stage was significantly shorter (P = 0.0003; 95% confidence interval (CI) -1.17, -0.27 h) and the incidence of forceps delivery was lower (P = 0.032). Maternal satisfaction with epidural analgesia, as assessed by VAS, was higher in group A (P = 0.04; 95% CI -0.001, 10.001).
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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 Comparative Study Clinical Trial
Postoperative patient-controlled epidural analgesia with opioid bupivacaine mixtures.
To determine the efficacy and safety of patient-controlled epidural analgesia of morphine or fentanyl in combination with bupivacaine for postoperative pain relief. ⋯ Both methods were effective in the prevention of pain but, because of fewer side effects, fentanyl may be preferable to morphine.
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Randomized Controlled Trial Clinical Trial
Preoperative education and outcome of patient controlled analgesia.
To determine the effect of intensive preoperative education on the outcome of Patient Controlled Analgesia (PCA) postoperatively. ⋯ Our results suggest that specific preoperative education of patients using PCA does not alter pain scores, morphine consumption or patient satisfaction but may result in earlier and more effective use of anti-emetic medication.
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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.