Articles: analgesia.
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Recent evidence has documented the deleterious physiologic effects of pain and the beneficial results of effective postoperative analgesia. As outlined in this article, a three-step approach is recommended depending on the severity of pain. ⋯ All three choices may significantly impact on the efficacy of analgesia. While we continue to use primarily intravenous opioids to treat moderate and severe pain in the hospital setting, future formulations and developments may allow for the increased use of non-parenteral routes.
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Acta Anaesthesiol Scand · Aug 1997
Weight gain during pregnancy does not influence the spread of spinal analgesia in the term parturient.
It is still controversial whether the spread of spinal anaesthesia in pregnancy is influenced by particular physique. Investigation was based on a clinical observation that parturients with a pronounced "pregnant" physique, e.g. generalised oedema and heavy abdomen, tended to develop more cephalad sensory blockades than parturients without these physical signs. Using weight gain during pregnancy as a measure for the physique at term, we aimed to determine whether this parameter influences the distribution of analgesia after subarachnoidal injection of plain bupivacaine. ⋯ In parturients, weight gain during pregnancy, height, weight and body-mass index did not influence the extent of sensory analgesia after subarachnoidal administration of plain bupivacaine.
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Aust N Z J Obstet Gynaecol · Aug 1997
Factors influencing the selection of analgesia in spontaneously labouring nulliparous women at term.
We investigated the maternal characteristics, labour performance and delivery mode of 497 nulliparas entering labour spontaneously at term to identify the obstetric factors which influenced their choice of analgesia; 51.7% of these women used epidural analgesia. They were shorter (163 versus 165 cm, p = 0.002) and the mean gestation was 3 days greater than those not using epidural analgesia (40.2 versus 39.6 weeks, p = 0.0007). Median birth-weight in the epidural group was greater by 155 g (3,450 versus 3,295 gs, p = 0.0001). ⋯ Oxytocin augmentation was strongly associated with an increased risk of operative intervention regardless of analgesia. Selection of intrapartum analgesia is not a random event and epidural analgesia appears to be an indicator of abnormal labour patterns. To further investigate the impact of analgesic methods on nulliparous labour we are currently conducting a prospective randomized controlled trial.
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J Paediatr Child Health · Aug 1997
Case ReportsNurse-controlled analgesia using a patient-controlled analgesia device: an alternative strategy in the management of severe cancer pain in children.
Nurse-controlled analgesia (NCA) using a patient-controlled analgesia (PCA) device has been described for intensive care and postoperative use. This report describes the effective use of this technique for severe episodic and procedural pain in four children with advanced malignancy and high opioid requirements where conventional parenteral analgesia had been inadequate. Both morphine and fentanyl were used. Average duration of NCA was 6.75 days (range 4-12).