Articles: analgesia.
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Pain control at the end of life is almost always achievable regardless of the cause. Most of the principles for managing pain at the end of life are derived from cancer practice. ⋯ It determines the appropriate analgesic therapy; drug dose and route of administration; drug dosing intervals; titration of drug doses; control and prevention of analgesic side effects; and application of adjuvant, loco-regional (nonsystemic), and invasive treatments. A comprehensive approach that integrates patient preferences and management of psychosocial and spiritual/existential components of the patient's pain and suffering with physical components will improve analgesia, reduce the burden of the illness and its treatment, and improve the patient's quality of life.
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Letter Case Reports
Inadvertent dural tap related to problems with a loss of resistance device.
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Randomized Controlled Trial Clinical Trial
Does the addition of clonidine affect duration of analgesia of bupivacaine wound infiltration in inguinal hernia surgery?
We conducted a prospective, randomized, double-blind study to compare analgesia obtained by wound infiltration using 29 ml of 0.25% bupivacaine alone, or with the addition of clonidine hydrochloride 150 micrograms. A third group received bupivacaine wound infiltration with clonidine 150 micrograms i.m. to control for the systemic effects caused by absorption of clonidine. We studied 46 adults undergoing elective inguinal hernia repair. ⋯ Visual analogue scores (VAS) at rest and after coughing were noted over a 24-h period. The only difference was higher VAS scores at rest at 24 h in the control group who received i.m. clonidine. We conclude that for elective inguinal hernia repair, postoperative analgesia obtained by bupivacaine wound infiltration was not improved by the addition of clonidine 150 micrograms.