Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia following major gynecological laparoscopic surgery--PCA versus intermittent intramuscular injection.
To compare the use of patient-controlled analgesia to intermittent intramuscular injections of morphine following major gynecological laparoscopic procedures in order to assess differences in level of pain, sedation, episodes of nausea and/or vomiting, hospitalization time and patient satisfaction with their postoperative analgesia. ⋯ It is important for the surgeon to be aware of the effects of postoperative analgesia on his or her patients' level of satisfaction. We do not recommend the use of PCA analgesia following major laparoscopic gynecological surgery.
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We analysed retrospectively the link between the incidence of epidural analgesia and the frequency distribution of instrumental delivery, caesarean section, labour induction and parity in a selected group of women with a low risk labour profile in all (85) obstetric units in Flanders (Northern Belgium). A group of 104 932 women with presumed low risk labour profile was subjected to analysis. ⋯ The incidence of instrumental delivery in a given unit was greatly influenced by the rate of epidural analgesia and labour induction for convenience (P < 0.001). However, the incidence of caesarean section in a given unit was not determined by either the rates of epidural, labour induction, attempted instrumental delivery or the size of the unit.
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Objectives. To test the efficacy and safety of intraspinal opioids for patients with nonmalignant pain. Design. ⋯ Conclusions. Long-term intrathecal opioids are efficacious, practical, and safe for the treatment of nonmalignant pain syndromes. FBSS patients respond similarly to intraspinal analgesia as the patients with neuropathic pain, while the group with mixed pain from other non-FBSS causes respond similarly to the nociceptive pain patients.
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Paediatric anaesthesia · Jan 1998
Randomized Controlled Trial Clinical TrialModifying infant stress responses to major surgery: spinal vs extradural vs opioid analgesia.
Twenty-six infants due to undergo major abdominal or thoracic surgery under general anaesthesia were randomized to receive additional analgesia with group A) spinal/epidural analgesia; B) epidural analgesia or C) opioid analgesia with fentanyl. We wished to determine if spinal analgesia followed by epidural analgesia might result in more complete control of cardiovascular or stress responses than the other two treatment groups. Heart rate and blood pressure were recorded at five min intervals throughout surgery. ⋯ Systolic blood pressures were higher in group C compared to A and B. The rise in plasma glucose concentrations was significantly different between the groups in the order C > B > A (P < 0.05). A similar trend was seen in the plasma adrenaline and noradrenaline concentrations but this failed to achieve significance due to the limited sample size.
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Clinical Trial Controlled Clinical Trial
Minimum local analgesic concentration of extradural bupivacaine increases with progression of labour.
We have used the technique of double-blind sequential allocation to quantify the minimum local analgesic concentration (MLAC) of extradural bupivacaine for women in early (median cervical dilatation 2 cm) and late (median cervical dilatation 5 cm) labour. The first bolus was 20 ml of the bupivacaine test solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of bupivacaine according to up and down sequential allocation. ⋯ In early labour, the MLAC of bupivacaine was 0.048% w/v (95% confidence intervals (CI) 0.037-0.058% w/v), and 0.140% w/v (95% CI 0.132-0.150% w/v) in the late group. The MLAC of bupivacaine in late labour was greater by a factor of 2.9 (95% CI 2.7-3.2) compared with the MLAC in early labour (P < 0.0001, 95% CI difference 0.08-0.11). We conclude that advancing labour requires an increased concentration of extradural bupivacaine for pain relief.