Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
[Postoperative epidural fentanyl administration in patients for hysterectomy with para-aortic lymph node resection].
In our experience, continuous epidural administration of fentanyl in doses of 12.5 micrograms.h-1, has not been sufficient to relieve postoperative pain in patients after hysterectomy with para-aortic lymph node resection. Thus, a prospective, randomized, single-blind study was performed to compare the analgesic efficacy of fentanyl 25 micrograms.h-1 with 12.5 micrograms.h-1 in these patients for 48 hours after surgery. Twenty-one women undergoing hysterectomy with para-aortic lymph node resection were allocated into three groups; Group C (control, n = 7): fentanyl 12.5 micrograms.h-1, infusion rate 2 ml.h-1, Group S2 (double speed, n = 7): fentanyl 25 micrograms.h-1, infusion rate 4 ml.h-1, and Group C2 (double concentration, n = 7): fentanyl 25 micrograms.h-1, infusion rate 2 ml.h-1. ⋯ At movement, the analgesic efficacy was not sufficient in any groups, but, at rest, groups S2 and C2 experienced significantly less pain than the group C. The degree of pain relief was not different between groups S2 and C2. In conclusion, epidural fentanyl 25 micrograms.h-1 provided significantly superior analgesia compared with epidural fentanyl 12.5 micrograms.h-1.
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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.
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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).
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Clinical Trial
[Epidural fentanyl provide sufficient analgesia for extracorporeal shock wave lithotripsy (ESWL)].
Epidural fentanyl (0.2 mg in 10 ml normal saline) was administrated in 10 unpremedicated patients undergoing extracorporeal shock wave lithotripsy (ESWL). No test dose of local anesthetics was administrated and accessory drugs such as narcotics or analgesics were not used. Painful procedures except for shock wave such as insertion of urethral catheter were not applied. ⋯ Respiratory rate and Spo2 slightly decreased during ESWL. Postoperative side effects were mild especially in the patients treated with epidural fentanyl alone. Epidural fentanyl is considered to be useful analgesic technique for ESWL.
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Although it is frequently stated in the literature that thoracotomy is one of the most painful operative incisions, few data supporting this view are available. ⋯ The common belief that posterolateral thoracotomy is a very painful operative access is not true. Therefore it is not necessary to use special techniques for postthoracotomy pain relief in these patients. Patient-controlled analgesia is sufficient for pain relief after major thoracic or abdominal incisions.