Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Addition of adrenaline to pethidine for epidural analgesia after caesarean section.
We have investigated the addition of adrenaline to epidural pethidine for postoperative analgesia in 40 patients after Caesarean section. In a randomised, double-blind study, patients received pethidine 25 mg with adrenaline 50 micrograms (adrenaline group, n = 20) or pethidine 25 mg without adrenaline (plain group, n = 18) epidurally at the first request for postoperative analgesia. ⋯ Visual analogue scale pain scores in the first 30 min after injection and onset of analgesia, defined by the time for pain scores to decrease by 50%, were similar between groups. Addition of adrenaline to epidural pethidine has advantages for analgesia after Caesarean section.
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Acta Anaesthesiol. Sin. · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialIntermittent bolus versus patient-controlled epidural morphine for postoperative analgesia.
Patient-controlled epidural analgesia (PCEA) is a technique that combines the flexibility and convenience of PCA with the intrinsic analgesic efficacy of epidurally administered opioids. The aim of this study is to compare the analgesic and side effects of intermittent bolus injections of epidural morphine with PCEA using morphine during the first 24 h after elective low abdominal surgery. ⋯ PCEA with morphine decreases morphine consumption and with less adverse effects than intermittent bolus of epidural morphine. PCEA with morphine is an acceptable alternative to epidural morphine after low abdominal surgery.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Intravenous neostigmine enhances the analgesic effect of epidural anesthesia].
A single-blind trial of the intravenous neostigmine on epidural anesthesia was carried out on 75 patients undergoing lower limb or lower abdominal surgery. They were allocated to three groups of 25: patients of group C received 2 ml of 0.9% saline, patients of group AN 1 ml (0.5 mg) of atropine and 2 ml (1 mg) of neostigmine, and patients of group N 2 ml (1 mg) of neostigmine, intravenously 5 min before epidural injection of 15 ml of 2% mepivacaine solution without epinephrine. We assessed the onset and spread of cold sensory block and analgesia, and the degree of motor block and sedation. ⋯ The incidence of bradycardia and fecal incontinence was significantly higher in group N than in groups C and AN. These results demonstrate that intravenous neostigmine potentiates the analgesic effect of epidural anesthesia mediated by a cholinergic muscarinic mechanism. However, in clinical practice, it does not seem to be useful, because of the side effects.
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Comparative Study
Increased neurologic complications associated with postoperative epidural analgesia after tibial fracture fixation.
A retrospective study of 63 patients with surgically treated tibial fractures was performed. The type of postoperative analgesia was compared against the type of fracture, mechanism of injury, type of fixation, adequacy of pain control, and incidence of neurologic complications. The only difference observed among all of these comparisons was that patients given postoperative epidural analgesia with local anesthetics were 4.1 times more likely to have a neurologic complication than those receiving systemic narcotics (P = 0.0496). We conclude that patients who have undergone surgical treatment of tibial plateau or shaft fractures have a significantly higher risk of developing neurologic complications when post-operative epidural analgesia is used.
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Until today, the use of epidural analgesia in obstetrics still remains controversial. In the opinion of many obstetricians the use of an epidural for a healthy laboring parturient is not necessary and can lead to potentially harmful side effects. However, painful labor leads to a maternal stress reaction with the release of epinephrine and norepinephrine. ⋯ Several studies show that epidural analgesia can attenuate the maternal stress reaction and thereby improve maternal and fetal well-being, as long as precautions are taken. The avoidance of maternal hypotension with sufficient volume preload with lactated Ringer's solution or colloids, and decreasing the concentration of local anaesthetics by adding opioids will prevent an increase in instrumental deliveries. With the use of patient-controlled epidural analgesia (PCEA) the amount of local anaesthetics can even further be reduced.