Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Decreased incidence of complications in parturients with the arrow (FlexTip Plus) epidural catheter.
To compare the incidence of complications during placement of Arrow (FlexTip Plus) and Concord/Portex epidural catheters in parturients receiving continuous epidural analgesia. ⋯ Compared with a less flexible catheter, the Arrow decreases the incidence of transient paresthesiae and inadvertent venous cannulation, while improving the ability to thread the catheter into the epidural space. Intravascular injection, transarachnoid migration, and the rare occurrence of epidural haematoma may be further reduced with the use of flexible, soft-tip catheters.
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Int J Obstet Anesth · Apr 1998
Maternal temperature during labour using low-dose (ambulatory) epidural analgesia with bupivacaine and fentanyl.
Maternal temperature is known to increase during labour with conventional epidural analgesia mixtures. To date, the effect of newer low-dose (ambulatory) epidural concentrations on maternal temperature has not been studied. Twenty-six women in established labour received epidural analgesia with 0.1% bupivacaine and 2 microg/ml fentanyl. ⋯ There was no significant overall rise in maternal temperature during labour with the use of an ambulatory epidural mixture. One patient exhibited an increase in temperature of 0.8 degrees C to 38 degrees C after 720 min and another of 1.1 degrees C to 38.1 degrees C after 630 min. We conclude that, whilst overall maternal temperature does not increase following low-dose epidural analgesia, individual increases may still occur after 10 h.
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Anesthesia and analgesia · Apr 1998
Randomized Controlled Trial Clinical TrialEpidural verapamil reduces analgesic consumption after lower abdominal surgery.
In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to investigate the possible role of the calcium channel blocker, verapamil, in postoperative pain. One hundred patients (ASA physical class I or II) scheduled for lower abdominal surgery were randomly assigned to one of four groups. Group 1 received 10 mL of 0.5% epidural bupivacaine injected 15 min before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 2 received 10 mL of epidural normal saline injected before incision, followed by 10 mL of 0.5% epidural bupivacaine 30 min after incision. Group 3 received 10 mL of 0.5% epidural bupivacaine plus 5 mg of verapamil injected before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 4 received the same drugs as Group 3, in the reverse order. Pain and mood numeric rating scores, sedation scores, Prince Henry scores, patient-controlled cumulative postoperative analgesic consumption, and the incidence of side effects were assessed 2, 6, 12, 24, and 48 h after the operation in each group. Cumulative postoperative analgesic consumption in Groups 3 and 4 was significantly lower (P < 0.05) than that in Groups 1 and 2 24 and 48 h after surgery. There were no differences in the pain, mood, and sedation scores and the incidence of side effects among the four groups. We conclude that epidural verapamil decreases postoperative pain, possibly by interfering with normal sensory processing and by preventing the establishment of central sensitization. ⋯ Calcium plays an important role in pain physiology at the spinal cord level. We examined the effect of bupivacaine plus verapamil (calcium channel blocker) and of bupivacaine alone. We demonstrated that the combination, administered epidurally, resulted in less postoperative analgesic consumption than bupivacaine alone.
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Infusion pumps incorporating 'Diprifusor' for the administration of propofol by target controlled infusion are now commercially available and are becoming more widely used. This paper considers possible future applications of target controlled infusion and summarises results obtained using prototype systems as a component of other control techniques and with other drugs. These include studies with patient-controlled systems for the administration of analgesia or sedation and a closed loop control system for the administration of propofol. Among currently available analgesic drugs, alfentanil and remifentanil are considered to be the most suitable for administration by target controlled infusion, but commercial systems for these agents are not yet available.
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Int J Obstet Anesth · Apr 1998
Labour analgesia in a patient with carnitine palmityl transferase deficiency and idiopathic thrombocytopenic purpura.
We report a case of a woman with carnitine palmityl deficiency (CPT) and idiopathic thrombocytopenic purpura, presenting in active labour at 38 weeks gestation. We discuss different anaesthetic factors involved with both diseases, and we propose an optimal management of such cases. Neuraxial analgesia with minimal motor blockade is indicated in early labour because it is necessary to alleviate stress in order to avoid rhabdomyolisis associated with CPT deficiency. Neuraxial analgesia is also needed because the theoretical risk of performing a caesarean section is higher than in a normal population, first because labour must be kept as short as possible and secondly because the possible thrombocytopenic in the baby precludes the use of instrumental delivery.