Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Thoracic epidural analgesia started after cardiopulmonary bypass. Adrenergic, cardiovascular and respiratory sequelae.
The effects of thoracic epidural analgesia started after cardiopulmonary bypass were studied on the subsequent adrenergic, cardiovascular and respiratory responses. Sixteen cardiac surgical patients received either a standardised general anaesthetic (control group) or a standardised general anaesthetic and thoracic epidural analgesia (epidural group). The epidural catheter was sited before surgery and heparinisation. ⋯ Postoperative respiratory function was less impaired in the epidural group, with higher forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow (p < 0.05). Pain scores were also significantly lower in the epidural group (p < 0.05). There were no significant differences in cardiovascular parameters.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialContinuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery.
The purpose of this study was to determine whether a lumbar epidural infusion of ropivacaine 0.2% would provide effective analgesia with an acceptably low incidence of motor blockade and side effects after lower abdominal surgery. After combined general and epidural anesthesia and surgery, 125 patients were randomly assigned to receive either saline or ropivacaine 0.2% at a rate of 6, 8, 10, 12, or 14 mL/h (Groups R6, R8, R10, R12, and R14, respectively) for 21 h. Supplemental analgesia, if required, was provided with intravenous patient-controlled analgesia with morphine. ⋯ Sensory blockade at 8 and 21 h was greater in the ropivacaine groups compared with the saline group. Approximately 30% of R8, R10, and R12 patients, and 63% of R14 patients had demonstrable motor block of the lower limbs at 21 hours. We conclude that lumbar epidural ropivacaine 0.2% reduces parenteral morphine requirements but has little effect on pain scores and may be associated with motor blockade.
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Randomized Controlled Trial Clinical Trial
Bupivacaine decreases epidural meperidine requirements after abdominal surgery.
The purpose of this study was to determine the optimal of three concentrations of bupivacaine (0.0%, 0.05%, 0.10%) to add to an epidural infusion of meperidine (1 mg.ml-1) for postoperative pain relief. ⋯ Although analgesia was identical among groups, the lower serum concentrations of meperidine support the addition of bupivacaine 0.10% to meperidine when administered as a continuous infusion following abdominal surgery.
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To review recent acute pain management care issues in a pediatric emergency department (ED) in order to identify opportunities for a performance improvement program. ⋯ These data from 1994 document suboptimal analgesic use and home analgesic instruction for children in our ED with burns and fractures. Other opportunities in our ED for acute pain management improvement include optimizing initial analgesic doses, shortening the time elapsed to initial analgesic administration, and documenting the response to pain management.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialMorphine patient-controlled analgesia is superior to meperidine patient-controlled analgesia for postoperative pain.
The choice between morphine and meperidine for postoperative pain is usually based on the preference of the prescriber, as few objective comparative data are available. This blind, randomized study compared the efficacy and side effects of morphine and meperidine administered by patient-controlled analgesia (PCA) for postoperative pain. One hundred two consenting patients scheduled for major abdominal surgery were randomly assigned to receive PCA with morphine (0.75, 1.0, or 1.5 mg bolus dose size) or meperidine (9, 12, or 18 mg) for pain control. ⋯ Meperidine use was associated with poorer performance in the trailmaking tests and a greater incidence of dryness of the mouth. Severity of nausea, mood, and incidence of unusual dreams did not differ significantly between drugs. We conclude that meperidine should be reserved for those patients in whom morphine is judged inappropriate.