Articles: analgesia.
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Safe effective analgesia for neonates undergoing major surgery remains a challenge particularly in institutions where resources are limited. The experience in the use of epidural analgesia in 240 neonates weighing between 0.9-5.8 kg body weight (lumbar n = 211, thoracic n = 29) is reviewed. Dural puncture (n = 1), convulsion (n = 1) and intravascular migration of catheter (n = 1) were the only complications. ⋯ Skin epidural distance ranged between 3 and 12 mm (mean 6.0 +/- 1.7 mm) and did not correlate with the patients' weight. Patients remained haemodynamically stable except occasional bradycardia below 100 (n = 15) which was successfully managed with anticholinergics. The potential risks and benefits of epidural analgesia in this age group are discussed and arguments for intermittent 'top-up' doses rather than continuous infusions presented.
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Anaesthesiol Reanim · Jan 1998
Review[Introduction of patient-controlled analgesia--an interim report].
In spite of improved therapeutic methods, the number of patients who suffer from moderate or severe postoperative pain remains high at 30 to 70%. It is accepted that improvement of the organization of postoperative pain therapy is a necessary precondition for changing this situation. Therefore, patient-controlled analgesia (PCA) using pain-pumps should be recognized and the effect on the whole postoperative pain therapy of a university clinic observed. ⋯ Because of these fundamental changes, the frequency of the application of pain-pumps increased six-fold within one year. Additionally, rapid pain treatment based on patients' needs increased clearly from 9.2 to 30.8%. The standardized introduction of PCA had an extremely favourable effect on the whole postoperative pain therapy and can thus be wholeheartedly recommended.
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Ann Fr Anesth Reanim · Jan 1998
Review[Postoperative pain. Particularities in the child of less than 5 years, neonatology excluded].
For many years, postoperative pain has been undertreated in children less than 5 years old in comparison to adults. The assessment of pain is indeed difficult in this range of age, and only the scales of hetero-evaluation are used. The guidelines for treatment are similar as in adults: systematic administration, balanced analgesia, evaluation of pain and potential adverse effects. ⋯ Morphine remains the drug of choice among opioids; however the risk of respiratory depression in higher in infants less than 3 months old. Nalbuphine is also widely used in paediatrics. In addition, regional anaesthesia, either in single shot for minor surgery, or in continuous administration through epidural catheter for major surgery, has changed the management of postoperative pain in paediatrics.
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The pre-emptive analgesia concept suggests that pre-administration of analgesics may enhance the efficacy of these drugs. This review has selected the data from the literature according to two types of methodological criteria: Sackett's criteria, and those specific of pre-emptive analgesia studies. Infiltration, spinal and peripheral nerve blocks using local anaesthetic drugs do not seem to produce pre-emptive analgesia. ⋯ In other cases (NSAIDs, ketamine), pre-administration represents a change in usual practice. This is not justified for NSAIDs; NMDA receptor antagonists may offer an interesting research area. Data concerning pre-emptive analgesia for chronic pain syndrome such as phantom limb pain are quite limited.
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Ann Fr Anesth Reanim · Jan 1998
Comparative Study-Anesthesia and analgesia practice patterns in French obstetrical patients-.
To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS). ⋯ In France in 1991, the average rate of 37.2% for EA for obstetrics was high when compared to the rate in United Kingdom. It was equivalent to those in United States and Ontario, Canada. The discrepancies between hospitals were mainly related to structural and organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. However, the difference between GA and UH and PH is a French particularity. The high rate of GA for CS differs largely with those in the UK or the USA. The time saving aspect of GA was probably an important factor for the choice of this technique. This study must be reactualized and enlarged to determine the demand of EA for labour by parturients and obstetricians.