Articles: analgesia.
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The regional application of opioids close to the spinal cord by using pumps induces a pain reduction comparable to the systemic medication of the WHO analgesic ladder. However, this method does not reduce the side effects of these drugs, e.g. nausea, vomiting, dysfunctional bladder emptying, and obstipation. ⋯ Catheters and port systems have to be revised in 15% of all cases. Therefore, the indication for this method has to be considered carefully and includes the following criteria: pain of somatic origin, exclusion of mental diseases and psychogenic causes of pain, causal therapy is exhausted, insufficient effects of peripheral analgesics and co-analgesics, oral or transdermal opioids are insufficient despite dosages resulting in side-effects, pain is sensible to opioids, regional application of opioids has been tested effective before implantation.
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Ann Fr Anesth Reanim · Jan 1998
Review[Postoperative locoregional analgesia in the adult: epidural and peripheral techniques. Indications, adverse effects and monitoring].
Regional analgesia is a very effective way to treat postoperative pain. Lumbar and thoracic epidural analgesia are well adapted to major abdominal and thoracic surgery. Nevertheless, respiratory side effects induced by opioids are potentially severe and an adequate monitoring is essential. ⋯ Benefits of postoperative regional analgesia on mortality and morbidity are not demonstrated. Medical and nursing staff and specialized units should improve quality of postoperative regional analgesia as well. General guidelines for the practice of regional anaesthesia must be closely followed.
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Br J Clin Pharmacol · Jan 1998
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialThe effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy.
Postoperative nausea and vomiting (PONV) may be exacerbated by postoperative opioid analgesics and may limit patients' successful use of these medications when used with patient controlled analgesia (PCA). We tested the hypothesis that the rapid change in blood morphine concentration associated with PCA bolus delivery contributed to PONV, and that prolonging its delivery to a brief infusion would result in decreased PONV. ⋯ Reasons for these unexpected findings remain speculative. The high incidence of PONV appears to be inherently high in gynaecological surgery patients and standard antiemetic medication regimens appear to be poorly efficacious. Reasons for the differences in the time-course of emetic episodes between the two groups may be related to differences in the time-course of central opioid receptor occupancy.
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While Horner's syndrome is a rare and occasionally reported complication of epidural 'top-ups' administered for labour and Caesarean delivery, the case reported here followed a low-dose epidural infusion of bupivacaine. Low-dose epidural infusions have generally been regarded as a safer alternative to bolus doses in labour. It is also the case that close supervision is deemed unnecessary in some centres where the mother is receiving such an epidural infusion. This case is reported in order to highlight the potential dangers of a low-dose regime which in spite of the lack of early warning signs may be associated with a high block.