Articles: analgesia.
-
A nation-wide survey of pain relief in childbirth in Hungary was carried out in 1993. Information was provided on 104 137 deliveries in 98 units. The frequencies of different methods of pain relief for vaginal delivery were as follows: systemic opiates in 7387 cases (8.3%), epidural analgesia in 4611 cases (5.2%) and inhalational analgesia (nitrous oxide) in 4470 cases (5%). ⋯ For 71 744 vaginal deliveries (80.5%) no pain relief was provided at all. For caesarean section (n = 13240) the rate of spinal or epidural anaesthesia was 36.7%. It was concluded that despite an increasing rate of pain relief in labour elsewhere, the numbers of epidurals are still rather low in Hungary.
-
Int J Obstet Anesth · Oct 1997
Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia.
Parturients have the greatest risk of postdural puncture headache. use of a pencil-point needle, such as the 25 gauge Whitacre, has been associated with a lower incidence of PDPH. This observational study of 1009 obstetrical patients assessed possible factors related to the incidence of PDPH and other complications associated with spinal anesthesia using the 25 gauge Whitacre needle. The independent variables included procedure, maternal position at insertion, ease of insertion, intraoperative i.v. analgesia supplementation, use of intrathecal narcotics, parity and type of local anesthetic. ⋯ Six patients (0.59%) required epidural blood patch. There were eight (0.8%) failed finals which were converted to general anesthesia. None of the factors evaluated were significant in predicting the occurrence of PDPH.
-
Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialDoes dextrose affect analgesia or the side effects of intrathecal sufentanil?
Intrathecal (i.t.) sufentanil provides rapid effective pain relief for early labor, but it also produces undesirable side effects, which may be primarily related to cephalad spread. Although the combination of dextrose and positioning the patient head-up limits the spread of other spinally administered drugs, these factors have not been examined in laboring women receiving i.t. sufentanil. We hypothesized that the addition of dextrose to i.t. sufentanil injected with women in the sitting position would limit cephalad spread and side effects. Sixty-six healthy nulliparous parturients in early labor were randomized to receive 2-mL i.t. injections of sufentanil 10 micrograms plus saline with patients in either the lateral decubitus or sitting position, sufentanil 10 micrograms plus dextrose 7.5% with patients in either the lateral decubitus or sitting positions, or plain dextrose 7.5%. Pain scores using a 10-cm visual analog pain scale, sensory block height, and side effects were recorded. Dextrose 7.5% did not affect cephalad spread, as measured by block height to pin testing, but it did significantly reduce the duration of analgesia and the incidence of pruritus from i.t. sufentanil administered to patients in the sitting position compared with patients in the lateral position. In contrast, patient position had no effect on analgesia or side effects in patients receiving i.t. sufentanil in saline. I.t. dextrose alone had no effect. ⋯ The authors conclude that the addition of dextrose to intrathecal sufentanil injected into patients in the sitting position reduces the duration of analgesia without significantly reducing side effects with the exception of pruritus, and therefore does not improve the clinical utility of intrathecal sufentanil.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic efficacy of a hydrocodone with ibuprofen combination compared with ibuprofen alone for the treatment of acute postoperative pain.
Hydrocodone is a semisynthetic opioid with analgesic and antitussive properties qualitatively similar to other opioid agonists. Ibuprofen is a nonsteroidal antiinflammatory agent with analgesic and antipyretic activity and is an effective, primarily peripheral-acting antiinflammatory analgesic. The objective of this clinical trial was to determine the additive analgesic effect of the combination of 15 mg hydrocodone bitartrate with 400 mg ibuprofen, relative to 400 mg ibuprofen alone and placebo, in the treatment of postoperative pain. ⋯ The combination of hydrocodone with ibuprofen was significantly superior to ibuprofen for all hourly analgesic evaluations, weighted sum of pain intensity differences (SPID), total pain relief (TOTPAR), and global rating of study medication. No patients in the hydrocodone with ibuprofen group required analgesic remedication during the 6-hour study period, compared with 25% and 82% in the ibuprofen and placebo groups, respectively. The analgesic superiority of 15 mg hydrocodone bitartrate combined with 400 mg ibuprofen compared with 400 mg ibuprofen alone was demonstrated across many efficacy variables.