Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Patient controlled analgesia and intramuscular injections: a comparisons of patient pain experiences and postoperative outcomes.
Despite relatively widespread use of various forms of patient controlled analgesia (PCA), there remain conflicting results in the literature as to the efficacy of PCA. This study was conducted to assess the efficacy and postoperative outcomes of intravenous PCA compared to intramuscular (IM) injections in 73 patients who received major abdominal surgery. These patients were randomly selected and randomly assigned preoperatively to receiving IM or PCA modes of analgesia postoperatively. ⋯ Locus of control was not found to be a major factor in satisfaction or pain levels. Subsequent meta-analyses have also failed to yield significant differences between IM and PCA groups except in patient satisfaction. It is recommended that expansion of PCA programmes with abdominal surgery patients be considered only in cases where there is fiscal advantage or where patient satisfaction can be a driving force.
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Rev Esp Anestesiol Reanim · Apr 1997
Randomized Controlled Trial Clinical Trial[Analgesic effectiveness and repercussions on the progress of labor of small doses of bupivacaine and fentanyl in continuous peridural perfusion].
To compare the analgesic efficacy and repercussion on labor of early administration of two different concentrations of bupivacaine/fentanyl in continuous epidural perfusion, in comparison with a control group receiving no epidural anesthesia. ⋯ Both solutions provide good analgesia during labor with minimum undesirable side effects. Low epidural doses of bupivacaine and fentanyl started early do not affect the course of labor.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone.
Epidural opioid analgesia can offer advantages over intravenous administration, however, opioid-related side effects are common after epidural administration. We studied the effect of adding nalbuphine (NB), an opioid agonist-antagonist, to hydromorphone (HM) for patient-controlled epidural analgesia (PCEA) in 78 healthy women after elective cesarean delivery. Patients were randomly assigned to one of four treatment groups. ⋯ Although the overall incidences of nausea (19%-35%) and pruritus (32%-62%) were similar in all four groups, the addition of NB decreased the need for bladder catheterization. The highest NB concentration resulted in increased PCA demands during the 32-h study period. In conclusion, the combination of HM 0.075 mg/mL and NB 0.04 mg/mL resulted in lower nausea scores and a decreased incidence of urinary retention compared with HM alone, without increasing the opioid analgesic requirement.
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Int J Obstet Anesth · Apr 1997
Breath pentane concentrations during labor and the effect of epidural analgesia on the pentane concentration.
Increased lipid peroxidation has been observed in pregnancy and particularly in preeclampsia. Pentane, a by-product of lipid peroxidation, can be measured in exhaled breath, and its measurement is considered a non-invasive method of assessing lipid peroxidation in vivo. We measured pentane levels in the breath of 36 healthy parturient women and examined the effect of epidural analgesia on the pentane level. ⋯ The breath pentane level was higher during labor (4.88 parts per billion [p.p.b.], 95% confidence interval 3.25-6.51 p.p.b.) than before the induction of labor (3.10 p.p.b., 95% confidence interval 2.01-4.19 p.p.b.). There was a significant decrease in the pentane level after the institution of epidural analgesia (2.27 p.p.b., 95% confidence interval 1.43-3.11 p.p.b.). Our results suggest that labor may be accompanied by an increase in lipid peroxidation, and epidural analgesia reverses this increase.
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To determine the rate of increase in serum bupivacaine concentration during continuous extrapleural infusion. ⋯ Continuous extrapleural infusion of bupivacaine over five days after thoracotomy is associated with a steady increase in total serum bupivacaine concentration and no elevation in free serum bupivacaine concentration.