Articles: analgesia.
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Intrathecal analgesia is a highly effective technique for pain relief in the first stage of labor. It is a technically simple procedure that can be easily learned by family physicians currently performing diagnostic lumbar puncture. Its effectiveness, simplicity, and low incidence of serious complications make it especially applicable to the practices of physicians delivering babies in areas where continuous epidural anesthesia is not available. This article describes the procedure of intrathecal analgesia, and discusses advantages, complications, side effects, and applications.
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To investigate current concerns that potent opioid drugs, such as fentanyl, used for labour regional analgesia may affect neonatal status, maternal and umbilical plasma concentrations of fentanyl and bupivacaine at delivery were measured in 40 nulliparous patients receiving low-dose combined spinal epidural analgesia. Neonatal assessments included Apgar scores, umbilical blood gases and neurobehavioural tests. All maternal and umbilical venous plasma concentrations were low. ⋯ Mean umbilical vein/maternal fentanyl ratios were 1.12 for total drug and 1.20 for free drug and values were unrelated to the last epidural bolus to delivery interval (r = 0.12, p = 0.49). There were no correlations between Apgar scores, umbilical blood gases or neurobehavioural scores and umbilical venous concentrations of either fentanyl or bupivacaine. The dose of fentanyl used for ambulatory combined spinal epidural analgesia would appear to have a negligible effect on neonatal condition.
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American heart journal · Jun 1997
Treatment of medically and surgically refractory angina pectoris with high thoracic epidural analgesia: initial clinical experience.
Surgical sympathectomy can relieve symptoms of angina in patients with refractory angina. However, in these high-risk patients this thoracic surgery may result in significant morbidity and mortality rates. Similar sympathetic blockade can now be produced with high thoracic epidural analgesia (HTEA). ⋯ Local infection developed in one patient, one had catheter occlusion caused by fibrosis, and one patient had chronic back pain exacerbation from a paraspinous muscle spasm. No patient had a myocardial infarction or a significant arrhythmia. In patients with otherwise intractable angina pectoris, HTEA is an effective modality that produces symptomatic relief of angina pectoris and allows increased activity level.
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To study the influence of postoperative analgesia on morbidity and mortality after esophagectomy. ⋯ Adequate postoperative analgesia is associated with lower cardiopulmonary complications, lower mortality and reduced cost in patients undergoing transthoracic esophagectomy.