Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia.
The authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery. ⋯ The use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation. The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.
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Am. J. Obstet. Gynecol. · Dec 1997
Randomized Controlled Trial Clinical TrialNulliparous active labor, epidural analgesia, and cesarean delivery for dystocia.
Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women. ⋯ With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.
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Acta Anaesthesiol. Sin. · Dec 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe analgesic effect of PCA buprenorphine in Taiwan's gynecologic patients.
The aim of this study was to evaluate the analgesic effect of PCA buprenorphine (intravenous) on postoperative pain in gynecologic patients of Taiwan and the potency ratio of buprenorphine versus morphine, a commonly used potent analgesic. ⋯ We found that PCA buprenorphine (intravenous) could be effective in the treatment of postoperative pain in the gynecologic patients in Taiwan and the potency ratio of buprenorphine versus morphine appeared to be 24:1.
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Anaesth Intensive Care · Dec 1997
Review Comparative StudyOpioid requirements and responses in Asians.
The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. ⋯ An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
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General cardiovascular properties of ketamine: "In vitro", ketamine has moderate negative inotropic effects. "In vivo", a significant central sympathomimetic action with consecutive hemodynamic effects is dominant. The sympathomimetic potency of ketamine is one of the most significant pharmacological features of the substance with direct clinical implications. Monoanaesthesia with S-(+)-ketamine: After application of racemic ketamine or S(+)-ketamine as well, identic and significant increases in plasma catecholamines, arterial pressure and heart rate are observed. This outstanding sympathomimetic action is beneficial in induction of patients with shock or asthmatic state. TIVA and analgosedation with S-(+)-ketamine and midazolam: The sympathomimetic effect of S(+)-ketamine, and racemic ketamine as well, is mitigated by midazolam. Nevertheless, significant increases in heart rate and arteriel pressure might be observed. Clinical use of the combination is common in short procedures like reposition maneuvers. Of greater importance is the use for analgosedation in patients with cardiovascular instability, particularly in patients with exogenous catecholamine demand. TIVA and analgosedation with S-(+)-ketamine and propofol: When S(+)-ketamine is combined with propofol, the sympatholytic effects of propofol are counteracted by S(+)-ketamine, and stable hemodynamic conditions are presented. This combination seems useful for TIVA in patients with hypotonic dysregulation or endocrine deficits like hypothyreosis and adrenal insufficiency. Furthermore, analgosedation with S(+)-ketamine and propofol is advantageous, when rapid recovery is necessary and negative circulatory effects should be avoided. ⋯ Sympathoadrenergic and hemodynamic effects of S(+)-ketamine and racemic ketamine are generally identical. The distinctest action is observed, when S(+)-ketamine is used as a monoanaesthetic. In combination with midazolam, a significant reduction is achieved. In combination with propofol, the sympatholytic effects of this hypnotic agent are compensated by S(+)-ketamine. With respect to sympathoadrenergic and hemodynamic reactions, the clinical position of S(+)-ketamine is unchanged. Nevertheless, a significant clinical progress can be expected due to improved recovery and reduced substance load, when racemic ketamine is replaced by S(+)-ketamine.