Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery.
Ninety boys, aged 13-53 months, undergoing repair of hypospadias, were allocated randomly to receive 0.8 ml kg-1 of one of three solutions into the caudal extradural space: group B received bupivacaine 2 mg kg-1, group T received tramadol 2 mg kg-1 in 0.9% saline and group BT a mixture of both. Postoperative pain was assessed hourly for 12 h after injection using a modified TPPPS pain score and additional analgesia was administered to those children whose pain scores were > 3/10. ⋯ There were no significant differences between the groups in mean ventilatory frequency, sedation scores, incidence of emesis, facial flushing or pruritus. We conclude that caudal tramadol had a slow onset of action and that the addition of tramadol to bupivacaine, when both drugs were administered caudally, did not significantly prolong the duration of action of bupivacaine.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Clinical TrialPostcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates.
Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia (PCA) with meperidine is associated with significantly more neonatal neurobehavioral depression than PCA with morphine. A single dose of epidural morphine (4 mg) decreases postcesarean opioid analgesic requirements and may reduce or prevent neonatal neurobehavioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping, each patient received epidural morphine 4 mg and was randomly allocated to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral Assessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to maternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The three infant groups were equivalent with respect to initial characteristics and NBAS scores on the first 2 days of life. On the third day of life, infants in the morphine group were significantly more alert and oriented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine group remained significantly more alert and oriented to animate human auditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphine and 4.7 mg/kg meperidine); however, even with these small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients. ⋯ Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia with meperidine is associated with more neonatal neurobehavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to meperidine.
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Journal of anesthesia · Sep 1997
Differential effects of ketamine and MK-801 on A-fiber and C-fiber responses of spinal wide dynamic range neurons in the cat.
To clarify whether ketamine suppresses both A-fiber-and C-fiber-mediated pain and to compare the effects of ketamine with those of MK-801. ⋯ Intravenous ketamine may suppress both A-and C-fiber-mediated pain at a subanesthetic dose. This finding could be a scientific basis for the usefulness of ketamine during clinical procedures such as dressing changes or débridement of the burned patient.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of single, end-holed and multi-orifice extradural catheters when used for continuous infusion of local anaesthetic during labour.
Single, end-holed and multi-orifice extradural catheters were compared in terms of efficacy and complications when used for infusion of 0.1% bupivacaine during labour. In this study of 364 patients there was no difference in unilateral block after an initial bolus dose (18 (11.5%) for single, end-holed and 16 (10.9%) for multi-orifice catheters). Unilateral block recurred with seven (4.0%) single, end-holed and with eight (4.8%) multi-orifice catheters. Unilateral blocks, arising for the first time during infusion of local anaesthetic, occurred significantly more frequently when single, end-holed catheters were used (29 (16.4%)) compared with multi-orifice catheters (14 (8.4%)) (P < 0.05).
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The Journal of urology · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialPenile block timing for postoperative analgesia of hypospadias repair in children.
It has been well established that a dorsal penile nerve block immediately after surgery decreases postoperative pain in children undergoing hypospadias repair. However, to our knowledge the efficacy of a penile block immediately before versus immediately after surgery for postoperative pain control has not been previously studied in such children. ⋯ Two penile blocks performed at the beginning and conclusion of hypospadias repair, respectively, provide better postoperative pain control than 1 penile block done before or after surgery (p < 0.05). These patients require less analgesic than those who receive a penile block only before or only after surgery.