Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peripheral morphine analgesia in dental surgery.
The recent identification of opioid receptors on peripheral nerve endings of primary afferent neurons and the expression of their mRNA in dorsal root ganglia support earlier experimental data about peripheral analgesic effects of locally applied opioids. These effects are most prominent under localized inflammatory conditions. The clinical use of such peripheral analgesic effects of opioids was soon investigated in numerous controlled clinical trials. ⋯ No serious side effects were reported. Our results show that 1 mg of morphine added to a local anesthetic for dental surgery results in significant improvement of postoperative analgesia. Since the majority of dental surgeries is accompanied with an inflammatory reaction, supplemental morphine may be of benefit for the relief of postoperative dental pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Addition of droperidol to morphine administered by the patient-controlled analgesia method: what is the optimal dose?
Eighty patients were recruited into a double-blind, randomized trial to find the optimal dose of droperidol for addition to the patient-controlled analgesia (PCA) morphine infusate for female patients undergoing gynaecological surgery. A standardized anaesthetic technique was employed. Post-operative analgesia was provided by PCA morphine. ⋯ However, after 24 h, patients in group 4 were significantly more sedated than patients in groups 1 and 2 (P < 0.05). There were no significant differences between the groups in terms of the incidence of anxiety or other side effects attributable to droperidol. The present authors suggest that, although the results demonstrate few statistically significant differences between the four groups, a PCA bolus dose of droperidol of 0.10 mg mL-1 appears to provide the optimal balance between anti-emetic efficacy and an acceptable incidence of side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pharmaco-economic evaluation of a disposable patient-controlled analgesia device and intramuscular analgesia in surgical patients.
The present study contrasted the pharmaco-economics and analgesic efficacy of intramuscular (i.m.) opioid treatment with a parenteral disposable patient-controlled analgesia (PCA) system in two groups of 20 female patients (ASA I-II, aged 35-69 years) scheduled for abdominal hysterectomy. The PCA group received a continuous infusion of 1.5 mg h-1 piritramide, a mu-opioid receptor agonist, with incremental doses of 1.5 mg (lock-out interval = 15 min). The i.m. group received 0.3 mg kg-1 piritramide i.m. when requested by the patient with a minimum interval of 5 h. ⋯ Both treatments initially provided comparable analgesia, but PCA was more efficient after 16 h and significantly reduced nursing time for pain treatment (PCA = 61 +/- 4 min, i.m. = 88 +/- 5 min; P < 0.001). Functional recovery was not different for either treatment. Cost analysis indicated a better cost-benefit ratio for the i.m. treatment (0.35 vs. 1.1 for PCA treatment), but a similar cost-effectiveness for both treatments (PCA = 1.9 Belgian Francs (BEF) unit-1 SPID; i.m. = 1.7 BEF unit-1 SPID).
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The safety of epidural infusion for postoperative analgesia in pediatric spine surgery continues to be established. A continuous epidural infusion of morphine sulfate and bupivacaine was used for postoperative analgesia in 12 pediatric patients undergoing spinal surgery. The epidural was placed intraoperatively by the operating surgeon, while continuous infusion was managed postoperatively by a pediatric anesthesiology pain service team. ⋯ Patients experienced analgesia as documented by a comprehensive pain scale form. No catheters failed, while side effects were minimal and easily managed. These results provide confirmation of the safety and efficacy of continuous epidural infusion for postoperative analgesia following pediatric spine surgery and evidence that patient-controlled epidural analgesia is an option.
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Randomized Controlled Trial Clinical Trial
Interactions between epidural analgesia and antifibrinolytics.