Articles: analgesia.
-
Many benefits can be obtained from the use of drugs applied locally or regionally when treating dogs and cats that are in pain or will be in pain because of surgical trauma. These techniques often use less medication than for systemic administration with a reduction in the likelihood of toxic effects from these compounds. ⋯ Other drugs, such as the opioids, may decrease the nociceptive input with minimal effect on motor activity. This report discusses the use of local anesthetics and other drugs for analgesia of the skin, mucous membranes, joints, pleura, and peritoneum, and the application of these drugs for regional blocks of peripheral nerves and epidural/intrathecal injection.
-
Clinical Trial
Evaluation of thoracic epidural catheter position and migration using radio-opaque catheters.
Migration of thoracic epidural radio-opaque catheters was evaluated in 25 patients scheduled for thoracic surgery in the supine position (n = 5) or in the lateral position with lateral extension of the thoracic spine (n = 20). Chest radiography was performed daily for 3 days after operation. ⋯ The catheter tip position was unchanged in all patients operated upon in the supine position. In the group operated upon in the lateral position, the catheter tip retracted from day 1 to day 2 by an average of 0.69 cm (SD 1.08; p < 0.05); from day 2 to day 3 the average retraction was 0.35 cm (SD 0.67; p < 0.05).
-
Case Reports
Compartment syndrome associated with bupivacaine and fentanyl epidural analgesia in pediatric orthopaedics.
Two patients had a compartment syndrome after surgery at a remote site performed under a continuous lumbar infusion of a mixture of narcotic (fentanyl) and local anesthetic (bupivacaine 0.1%). Each patient had inadvertent excessive pressure applied to the limb distally and had no perception of pain in the presence of this analgesic combination. After the relief of this pressure from a sling or traction apparatus, each child had signs of a compartment syndrome, and this sensation of pathologic pain was not masked by the epidural infusion. A discussion of the literature questions the benefits of bupivacaine local anesthetic as a routine addition to epidural analgesia for orthopaedic surgery.
-
The first anaesthesia-based acute pain service in Singapore is described. The benefits, risks and resource implications of such a service during its first two years are reviewed. ⋯ There were no reports of respiratory depression in the patient-controlled analgesia group. The authors conclude that the provision of an acute pain service in the local context was safe and resulted in excellent post-operative patient satisfaction.
-
Adequate treatment of pain in ICU patients should be an integral part of ICU management, as inadequately treated pain leads to a series of complications that may counteract the success of ICU treatment. For continuous intravenous use we recommend sufentanil in a dose of 0.75-1.0 microgram kg-1 h-1 in mechanically ventilated patients and in a dose of 0.25-0.35 microgram kg-1 h-1 in intubated and spontaneously breathing patients. ⋯ Patients with trauma to the thorax, pelvic fracture, or after major surgical interventions will be better managed by regional application of analgesic drugs alone or in combination with a systemic analgesic drug infusion. To achieve the best results it is necessary to be well informed and trained in the method, to know the advantages and disadvantages, the correct and modified dosages of the drugs used, and the indications and contraindications.